Incremental Dose Finding in Controlled-Release PTH Compounds

ABSTRACT

The present invention relates to pharmaceutical compositions comprising a controlled-release PTH compound or a pharmaceutically acceptable salt, hydrate, or solvate thereof, for use in a method of treating, controlling, delaying or preventing a condition which can be treated, controlled, delayed or prevented with PTH, wherein the pharmaceutical composition comprising the controlled-release PTH compound is administered in accordance with a dosage regimen in which dose adjustment in response to hypocalcemia or hypercalcemia is performed in increments of no more than 25%.

The present invention relates to pharmaceutical compositions comprisinga controlled-release PTH compound or a pharmaceutically acceptable salt,hydrate, or solvate thereof, for use in a method of treating,controlling, delaying or preventing a condition which can be treated,controlled, delayed or prevented with PTH, wherein the pharmaceuticalcomposition comprising the controlled-release PTH compound isadministered in accordance with a dosage regimen in which doseadjustment in response to hypocalcemia or hypercalcemia is performed inincrements of no more than 25%.

Hypoparathyroidism is a rare endocrine disorder of calcium and phosphatemetabolism that most often arises as a result of parathyroid glanddamage or removal during surgery of the thyroid gland.Hypoparathyroidism is unusual among endocrine disorders in that it hasnot been treated, until recently, by replacement with the missinghormone, parathyroid hormone, or PTH. Conventional therapy forhypoparathyroidism involves large doses of vitamin D and oral calciumsupplementation, which, although often effective, is associated withmarked swings in blood Ca²⁺ resulting in hypercalcemia and hypocalcemia,excess urinary calcium excretion, nephrocalcinosis, and ectopiccalcifications, including vascular, basal ganglia, and lens of eye.

Calcium is the most abundant mineral in the human body, and its tightregulation is required for many critical biological functions, such asbone mineralization, muscle contraction, nerve conduction, hormonerelease, and blood coagulation. It is particularly important to maintaincalcium concentration as stable as possible, because of the highsensitivity of a variety of cell systems or organs, including thecentral nervous system, muscle, and exo/endocrine glands, to smallvariations in Ca²⁺. PTH is a major regulator of calcium homeostasis.

The inappropriately low or frankly low PTH levels in relation to serumCa²⁺ concentration, characteristic of hypoparathyroidism, leads todecreased renal tubular reabsorption of Ca²⁺ and simultaneously, toincreased renal tubular reabsorption of phosphate. Thus, the mainbiochemical abnormalities of hypoparathyroidism are hypocalcemia andhyperphosphatemia. Clinical features of the disease include symptoms ofhypocalcemia, such as perioral numbness, paresthesias, and carpal/pedalmuscle spasms. Laryngeal spasm, tetany, and seizures are serious andpotentially life-threatening complications. Hyperphosphatemia and anelevated calcium x phosphate product contributes to ectopic depositionof insoluble calcium phosphate complexes in soft tissues, includingvasculature, brain, kidneys, and other organs.

Standard therapy of hypoparathyroidism is oral calcium and vitamin Dsupplementation. The goals of therapy are to a) ameliorate symptoms ofhypocalcemia; b) maintain fasting serum calcium within or slightly belowto the low-normal range; c) maintain fasting serum phosphorus within thehigh normal range or only slightly elevated; d) avoid or minimizehypercalciuria; e) maintain a calcium-phosphate product at levels wellbelow the upper limit of normal and f) avoid ectopic calcification ofthe kidney (stones and nephrocalcinosis) and other soft tissues.

Several concerns arise with prolonged use of calcium and active vitaminD in large doses, particularly with regard to hypercalciuria, kidneystones, nephrocalcinosis and ectopic soft tissue calcification. Inaddition, conventional therapy with calcium and active vitamin D doesnot alleviate quality of life complaints nor does it reverseabnormalities in bone remodeling characteristic of the disease. Inshort, there is a high need for improved therapies forhypoparathyroidism.

In 2015, Natpara, PTH(1-84), was approved for once-daily subcutaneousinjection as an adjunct to vitamin D and calcium in patients withhypoparathyroidism. Natpara, PTH(1-84), was approved to controlhypocalcemia based on a pivotal trial demonstrating that 42 percent ofPTH(1-84) treated participants achieved normal blood calcium levels onreduced doses of calcium supplements and active forms of vitamin D,compared to 3 percent of placebo-treated participants. Following a timecourse in which serum calcium was monitored after injection, 71 percentof patients treated with PTH(1-84) developed hypercalcemia at one ormore measurements during a 24-hour period. PTH(1-84) reduced urinarycalcium excretion 2-8 hours after injection but over the 24-hour period,urinary calcium excretion did not change. Similarly, urinary phosphateexcretion increased only during the first 8 hours after PTH(1-84)injection.

While this represents an important advance in the treatment of thedisease, Natpara has not demonstrated an ability to reduce incidences ofhypercalcemia (elevated serum calcium levels), hypocalcemia (low serumcalcium), or hypercalciuria (elevated urinary calcium) relative toconventional therapy in treated patients.

As such, there is a high need for improved PTH based therapies forhypoparathyroidism.

PTH(1-34), or teriparatide, was approved by the FDA in 2002 for thetreatment of osteoporosis. Despite not being approved for thisindication, PTH(1-34) has historically been used for treatment ofhypoparathyroidism with patients receiving twice- or thrice-dailyinjections. To facilitate more physiological PTH levels, clinicalstudies have been conducted with PTH(1-34) administered by pump deliveryin comparison with twice-daily injections. Over 6-months, pump deliveryproduced normal, steady state calcium levels with minimal fluctuationand avoided the rise in serum and urine calcium levels that are evidentsoon after PTH injection. The marked reduction in urinary calciumexcretion when PTH(1-34) is administered by pump may indicate that PTHmust be continuously exposed to the renal tubule for the renalcalcium-conserving effects to be realized. Pump delivery of PTH(1-34)achieved simultaneous normalization of markers of bone turnover, serumcalcium, and urine calcium excretion. These results were achieved with a65 percent lower daily PTH(1-34) dose and a reduced need for magnesiumsupplementation compared with the twice daily PTH(1-34) injectionregimen.

However, continuous pump therapy is inconvenient and challenging forpatients, and it is an object of the current invention to provide for amore convenient therapeutic option of providing continuous exposure toPTH.

Long-term daily administration of PTH is associated with a progressivecortical bone loss due to increased bone metabolism. In a 6-yearfollow-up of patients treated with PTH(1-84) (Rubin, JCEM 2016) boneturnover markers remained greater than pretreatment values, peaking atthe early years after PTH(1-84) initiation and declining thereafter butremaining significantly higher than baseline values by year 6. BMD byDXA was consistent with known site-specific effects of PTH, namelyincreases in lumbar spine and declines in distal ⅓ radius. The decreaseobserved at the distal one third radius is consistent with the knowneffects of intermittent PTH to increase cortical porosity and endostealresorption.

It is an object of this invention to provide for a method ofintermittently administering PTH, with improved control of serum andurine calcium, serum phosphorus, and lower elevation of bone turnovermarkers than currently applied PTH therapies. Preferably intermittentmeans with daily intervals, or more preferred with weekly intervals.

In the preclinical development program of both Forteo, PTH(1-34), andNatpara, PTH(1-84), a dose dependent increase in osteosarcoma rate wasobserved in rats treated with daily injections of the PTH compound. Inthe Natpara study, dosing of the high dose rats were discontinued due toexcessive deaths in this group, primarily from metastatic osteosarcoma.This is felt to be due to the sensitivity of rats to the anaboliceffects of intermittent PTH. In contrast, continuous exposure to PTH isknown to lack significant bone anabolic activity. As such is an objectof this invention to provide for an intermittent PTH replacement therapythat provides for an infusion-like profile of PTH, resulting in improvedsymptom control with a lower administered dose. Preferably intermittentmeans with daily intervals, or more preferred with weekly intervals.

In summary, there is a need for a more convenient and safer treatment ofhypoparathyroidism with reduced side-effects.

It is therefore an object of the present invention to at least partiallyovercome the shortcomings described above.

This object is achieved with a pharmaceutical composition comprising acontrolled-release PTH compound or a pharmaceutically acceptable salt,hydrate, or solvate thereof, for use in a method of treating,controlling, delaying or preventing a condition which can be treated,controlled, delayed or prevented with PTH, wherein the pharmaceuticalcomposition comprising the controlled-release PTH compound isadministered in accordance with a dosage regimen in which doseadjustment in response to hypocalcemia or hypercalcemia is performed inincrements of no more than 25%.

It was surprisingly found that such controlled-release PTH compound hasa higher potency than PTH 1-84, so dose adjustment for a pharmaceuticalcomposition comprising such controlled-release PTH compounds can beperformed in smaller increments than for pharmaceutical compositionscomprising PTH 1-84, in which doses in response to hypocalcemia orhypercalcemia are doubled or halved, respectively, in order to achievethe right dose. The typical starting dose is 50 μg/day, which istitrated down to 25 μg/day (50%) in the event of hypercalcemia, ortitrated up to 75 μg/day at first (50%) and then 100 μg/day (33.3%) inthe event of hypocalcemia, with most subjects requiring either 75 or 100μg/day.

Within the present invention the terms are used having the meaning asfollows.

As used herein the term “increment” refers to the increase or decreasein the amount of controlled-release PTH compound based on a previouslyadministered dose of the same controlled-release PTH compound whichincrease or decrease is given as a certain percentage based on theweight amount of the controlled-release PTH compound.

As used herein the term “controlled-release PTH compound” refers to anycompound, conjugate, crystal or admixture that comprises at least onePTH molecule or moiety and from which the at least one PTH molecule ormoiety is released with a release half-life of at least 12 hours.

As used herein the terms “release half-life” and “half-life” refer tothe time required under physiological conditions (i.e. aqueous buffer,pH 7.4, 37° C.) until half of all PTH or PTH moieties, respectively,comprised in a controlled-release PTH compound are released from saidcontrolled-release PTH compound.

As used herein the term “PTH” refers all PTH polypeptides, preferablyfrom mammalian species, more preferably from human and mammalianspecies, more preferably from human and murine species, as well as theirvariants, analogs, orthologs, homologs, and derivatives and fragmentsthereof, that are characterized by raising serum calcium and renalphosphorus excretion, and lowering serum phosphorus and renal calciumexcretion. The term “PTH” also refers to all PTHrP polypeptides, such asthe polypeptide of SEQ ID NO:121, that bind to and activate the commonPTH/PTHrP1 receptor. Preferably, the term “PTH” refers to the PTHpolypeptide of SEQ ID NO:51 as well as its variants, homologs andderivatives exhibiting essentially the same biological activity, i.e.raising serum calcium and renal phosphorus excretion, and lowering serumphosphorus and renal calcium excretion.

Preferably, the term “PTH” refers to the following polypeptidesequences:

(PTH 1-84) SEQ ID NO: 1SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADVNVLTKAKSQ (PTH 1-83) SEQ ID NO: 2SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADVNVLTKAKS (PTH 1-82) SEQ ID NO: 3SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADVNVLTKAK (PTH 1-81) SEQ ID NO: 4SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADVNVLTKA (PTH 1-80) SEQ ID NO: 5SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADVNVLTK (PTH 1-79) SEQ ID NO: 6SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADVNVLT (PTH 1-78) SEQ ID NO: 7SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADVNVL (PTH 1-77) SEQ ID NO: 8SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADVNV (PTH 1-76) SEQ ID NO: 9SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADVN (PTH 1-75) SEQ ID NO: 10SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADV (PTH 1-74) SEQ ID NO: 11SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKAD (PTH 1-73) SEQ ID NO: 12SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKA (PTH 1-72) SEQ ID NO: 13SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADK (PTH 1-71) SEQ ID NO: 14SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKED NVLVESHEKSLGEAD(PTH 1-70) SEQ ID NO: 15SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKED NVLVESHEKSLGEA(PTH 1-69) SEQ ID NO: 16SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKED NVLVESHEKSLGE(PTH 1-68) SEQ ID NO: 17SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKED NVLVESHEKSLG(PTH 1-67) SEQ ID NO: 18SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKED NVLVESHEKSL(PTH 1-66) SEQ ID NO: 19SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKED NVLVESHEKS(PTH 1-65) SEQ ID NO: 20SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKED NVLVESHEK(PTH 1-64) SEQ ID NO: 21SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKED NVLVESHE(PTH 1-63) SEQ ID NO: 22SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKED NVLVESH(PTH 1-62) SEQ ID NO: 23SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKED NVLVES(PTH 1-61) SEQ ID NO: 24SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKED NVLVE(PTH 1-60) SEQ ID NO: 25SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKED NVLV (PTH 1-59)SEQ ID NO: 26 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVL (PTH 1-58) SEQ ID NO: 27SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKED NV (PTH 1-57)SEQ ID NO: 28 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKED N(PTH 1-56) SEQ ID NO: 29SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKED (PTH 1-55)SEQ ID NO: 30 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKE(PTH 1-54) SEQ ID NO: 31SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKK (PTH 1-53)SEQ ID NO: 32 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRK(PTH 1-52) SEQ ID NO: 33SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPR (PTH 1-51)SEQ ID NO: 34 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRP(PTH 1-50) SEQ ID NO: 35SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQR (PTH 1-49)SEQ ID NO: 36 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQ(PTH 1-48) SEQ ID NO: 37SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGS (PTH 1-47)SEQ ID NO: 38 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAG (PTH 1-46)SEQ ID NO: 39 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDA (PTH 1-45)SEQ ID NO: 40 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRD (PTH 1-44)SEQ ID NO: 41 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPR (PTH 1-43)SEQ ID NO: 42 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAP (PTH 1-42)SEQ ID NO: 43 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLA (PTH 1-41)SEQ ID NO: 44 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPL (PTH 1-40)SEQ ID NO: 45 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAP (PTH 1-39)SEQ ID NO: 46 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGA (PTH 1-38)SEQ ID NO: 47 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALG (PTH 1-37)SEQ ID NO: 48 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVAL (PTH 1-36)SEQ ID NO: 49 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVA (PTH 1-35)SEQ ID NO: 50 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFV (PTH 1-34)SEQ ID NO: 51 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNF (PTH 1-33)SEQ ID NO: 52 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHN (PTH 1-32) SEQ ID NO: 53SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVH (PTH 1-31) SEQ ID NO: 54SVSEIQLMHNLGKHLNSMERVEWLRKKLQDV (PTH 1-30) SEQ ID NO: 55SVSEIQLMHNLGKHLNSMERVEWLRKKLQD (PTH 1-29) SEQ ID NO: 56SVSEIQLMHNLGKHLNSMERVEWLRKKLQ (PTH 1-28) SEQ ID NO: 57SVSEIQLMHNLGKHLNSMERVEWLRKKL (PTH 1-27) SEQ ID NO: 58SVSEIQLMHNLGKHLNSMERVEWLRKK (PTH 1-26) SEQ ID NO: 59SVSEIQLMHNLGKHLNSMERVEWLRK (PTH 1-25) SEQ ID NO: 60SVSEIQLMHNLGKHLNSMERVEWLR (amidated PTH 1-84) SEQ ID NO: 61SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADVNVLTKAKSQ; wherein the C-terminus is amidated(amidated PTH 1-83) SEQ ID NO: 62SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADVNVLTKAKS; wherein the C-terminus is amidated(amidated PTH 1-82) SEQ ID NO: 63SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADVNVLTKAK; wherein the C-terminus is amidated(amidated PTH 1-81) SEQ ID NO: 64SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADVNVLTKA; wherein the C-terminus is amidated(amidated PTH 1-80) SEQ ID NO: 65SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADVNVLTK; wherein the C-terminus is amidated(amidated PTH 1-79) SEQ ID NO: 66SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADVNVLT; wherein the C-terminus is amidated(amidated PTH 1-78) SEQ ID NO: 67SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADVNVL; wherein the C-terminus is amidated(amidated PTH 1-77) SEQ ID NO: 68SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADVNV; wherein the C-terminus is amidated(amidated PTH 1-76) SEQ ID NO: 69SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADVN; wherein the C-terminus is amidated(amidated PTH 1-75) SEQ ID NO: 70SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKADV; wherein the C-terminus is amidated(amidated PTH 1-74) SEQ ID NO: 71SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKAD; wherein the C-terminus is amidated(amidated PTH 1-73) SEQ ID NO: 72SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADKA; wherein the C-terminus is amidated(amidated PTH 1-72) SEQ ID NO: 73SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEADK; wherein the C-terminus is amidated (amidated PTH 1-71)SEQ ID NO: 74 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEAD; wherein the C-terminus is amidated (amidated PTH 1-70)SEQ ID NO: 75 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGEA; wherein the C-terminus is amidated (amidated PTH 1-69)SEQ ID NO: 76 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLGE; wherein the C-terminus is amidated (amidated PTH 1-68)SEQ ID NO: 77 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSLG; wherein the C-terminus is amidated (amidated PTH 1-67)SEQ ID NO: 78 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKSL; wherein the C-terminus is amidated (amidated PTH 1-66)SEQ ID NO: 79 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEKS; wherein the C-terminus is amidated (amidated PTH 1-65)SEQ ID NO: 80 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHEK; wherein the C-terminus is amidated (amidated PTH 1-64)SEQ ID NO: 81 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESHE; wherein the C-terminus is amidated (amidated PTH 1-63)SEQ ID NO: 82 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVESH; wherein the C-terminus is amidated (amidated PTH 1-62)SEQ ID NO: 83 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVES; wherein the C-terminus is amidated (amidated PTH 1-61)SEQ ID NO: 84 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLVE; wherein the C-terminus is amidated (amidated PTH 1-60)SEQ ID NO: 85 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVLV; wherein the C-terminus is amidated (amidated PTH 1-59)SEQ ID NO: 86 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNVL; wherein the C-terminus is amidated (amidated PTH 1-58)SEQ ID NO: 87 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDNV; wherein the C-terminus is amidated (amidated PTH 1-57) SEQ ID NO: 88SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKEDN; wherein the C-terminus is amidated (amidated PTH 1-56) SEQ ID NO: 89SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKED;wherein the C-terminus is amidated (amidated PTH 1-55) SEQ ID NO: 90SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKKE;wherein the C-terminus is amidated (amidated PTH 1-54) SEQ ID NO: 91SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRKK;wherein the C-terminus is amidated (amidated PTH 1-53) SEQ ID NO: 92SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPRK;wherein the C-terminus is amidated (amidated PTH 1-52) SEQ ID NO: 93SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPR;wherein the C-terminus is amidated (amidated PTH 1-51) SEQ ID NO: 94SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRP;wherein the C-terminus is amidated (amidated PTH 1-50) SEQ ID NO: 95SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQR; whereinthe C-terminus is amidated (amidated PTH 1-49) SEQ ID NO: 96SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQ; whereinthe C-terminus is amidated (amidated PTH 1-48) SEQ ID NO: 97SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGS; wherein theC-terminus is amidated (amidated PTH 1-47) SEQ ID NO: 98SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAG; wherein theC-terminus is amidated (amidated PTH 1-46) SEQ ID NO: 99SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDA; wherein the C-terminus is amidated (amidated PTH 1-45) SEQ ID NO: 100SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRD; wherein the C-terminus is amidated (amidated PTH 1-44) SEQ ID NO: 101SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPR; wherein the C-terminus is amidated (amidated PTH 1-43) SEQ ID NO: 102SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAP; wherein the C-terminus is amidated (amidated PTH 1-42) SEQ ID NO: 103SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLA; wherein the C-terminus is amidated (amidated PTH 1-41) SEQ ID NO: 104SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPL; wherein the C-terminusis amidated (amidated PTH 1-40) SEQ ID NO: 105SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAP; wherein the C-terminusis amidated (amidated PTH 1-39) SEQ ID NO: 106SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGA; wherein the C-terminus isamidated (amidated PTH 1-38) SEQ ID NO: 107SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALG; wherein the C-terminus isamidated (amidated PTH 1-37) SEQ ID NO: 108SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVAL; wherein the C-terminus isamidated (amidated PTH 1-36) SEQ ID NO: 109SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVA; wherein the C-terminus is amidated(amidated PTH 1-35) SEQ ID NO: 110SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFV; wherein the C-terminus is amidated(amidated PTH 1-34) SEQ ID NO: 111SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNF; wherein the C-terminus is amidated(amidated PTH 1-33) SEQ ID NO: 112SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHN; wherein the C-terminus is amidated(amidated PTH 1-32) SEQ ID NO: 113SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVH; wherein the C-terminus is amidated(amidated PTH 1-31) SEQ ID NO: 114SVSEIQLMHNLGKHLNSMERVEWLRKKLQDV; wherein the C-terminus is amidated(amidated PTH 1-30) SEQ ID NO: 115SVSEIQLMHNLGKHLNSMERVEWLRKKLQD; wherein the C-terminus is amidated(amidated PTH 1-29) SEQ ID NO: 116SVSEIQLMHNLGKHLNSMERVEWLRKKLQ; wherein the C-terminus is amidated(amidated PTH 1-28) SEQ ID NO: 117SVSEIQLMHNLGKHLNSMERVEWLRKKL; wherein the C-terminus is amidated(amidated PTH 1-27) SEQ ID NO: 118SVSEIQLMHNLGKHLNSMERVEWLRKK; wherein the C-terminus is amidated(amidated PTH 1-26) SEQ ID NO: 119SVSEIQLMHNLGKHLNSMERVEWLRK; wherein the C-terminus is amidated(amidated PTH 1-25) SEQ ID NO: 120SVSEIQLMHNLGKHLNSMERVEWLR; wherein the C-terminus is amidated (PTHrP)SEQ ID NO: 121AVSEHQLLHDKGKSIQDLRRRFFLHHLIAEIHTAEIRATSEVSPNSKPSPNTKNHPVRFGSDDEGRYLTQETNKVETYKEQPLKTPGKKKKGKPGKRKEQEKKKRRTRSAWLDSGVTGSGLEGDHLSDTSTTSLELDSRRH

More preferably, the term “PTH” refers to the sequence of SEQ ID:NOs 47,48, 49, 50, 51, 52, 53, 54, 55, 107, 108, 109, 110, 111, 112, 113, 114and 115. Even more preferably, the term “PTH” refers to the sequence ofSEQ ID:NOs 50, 51, 52, 110, 111 and 112. In a particularly preferredembodiment the term “PTH” refers to the sequence of SEQ ID NO:51.

As used herein, the term “PTH polypeptide variant” refers to apolypeptide from the same species that differs from a reference PTH orPTHrP polypeptide. Preferably, such reference is a PTH polypeptidesequence and has the sequence of SEQ ID NO:51. Generally, differencesare limited so that the amino acid sequence of the reference and thevariant are closely similar overall and, in many regions, identical.Preferably, PTH polypeptide variants are at least 70%, 80%, 90%, or 95%identical to a reference PTH or PTHrP polypeptide, preferably to the PTHpolypeptide of SEQ ID NO:51. By a polypeptide having an amino acidsequence at least, for example, 95% “identical” to a query amino acidsequence, it is intended that the amino acid sequence of the subjectpolypeptide is identical to the query sequence except that the subjectpolypeptide sequence may include up to five amino acid alterations pereach 100 amino acids of the query amino acid sequence. These alterationsof the reference sequence may occur at the amino (N-terminal) or carboxyterminal (C-terminal) positions of the reference amino acid sequence oranywhere between those terminal positions, interspersed eitherindividually among residues in the reference sequence or in one or morecontiguous groups within the reference sequence. The query sequence maybe an entire amino acid sequence of the reference sequence or anyfragment specified as described herein. Preferably, the query sequenceis the sequence of SEQ ID NO:51.

Such PTH polypeptide variants may be naturally occurring variants, suchas naturally occurring allelic variants encoded by one of severalalternate forms of a PTH or PTHrP occupying a given locus on achromosome or an organism, or isoforms encoded by naturally occurringsplice variants originating from a single primary transcript.Alternatively, a PTH polypeptide variant may be a variant that is notknown to occur naturally and that can be made by mutagenesis techniquesknown in the art.

It is known in the art that one or more amino acids may be deleted fromthe N-terminus or C-terminus of a bioactive polypeptide withoutsubstantial loss of biological function. Such N- and/or C-terminaldeletions are also encompassed by the term PTH polypeptide variant.

It is also recognized by one of ordinary skill in the art that someamino acid sequences of PTH or PTHrP polypeptides can be varied withoutsignificant effect of the structure or function of the polypeptide. Suchmutants include deletions, insertions, inversions, repeats, andsubstitutions selected according to general rules known in the art so asto have little effect on activity. For example, guidance concerning howto make phenotypically silent amino acid substitutions is provided inBowie et al. (1990), Science 247:1306-1310, which is hereby incorporatedby reference in its entirety, wherein the authors indicate that thereare two main approaches for studying the tolerance of the amino acidsequence to change.

The term PTH polypeptide also encompasses all PTH and PTHrP polypeptidesencoded by PTH and PTHrP analogs, orthologs, and/or species homologs. Itis also recognized by one of ordinary skill in the art that PTHrP andPTHrP analogs bind to an activate the common PTH/PTHrP1 receptor, so theterm PTH polypeptide also encompasses all PTHrP analogs. As used herein,the term “PTH analog” refers to PTH and PTHrP of different and unrelatedorganisms which perform the same functions in each organism but whichdid not originate from an ancestral structure that the organisms'ancestors had in common. Instead, analogous PTH and PTHrP aroseseparately and then later evolved to perform the same or similarfunctions. In other words, analogous PTH and PTHrP polypeptides arepolypeptides with quite different amino acid sequences but that performthe same biological activity, namely raising serum calcium and renalphosphorus excretion, and lowering serum phosphorus and renal calciumexcretion.

As used herein the term “PTH ortholog” refers to PTH and PTHrP withintwo different species which sequences are related to each other via acommon homologous PTH or PTHrP in an ancestral species, but which haveevolved to become different from each other.

As used herein, the term “PTH homolog” refers to PTH and PTHrP ofdifferent organisms which perform the same functions in each organismand which originate from an ancestral structure that the organisms'ancestors had in common. In other words, homologous PTH polypeptides arepolypeptides with quite similar amino acid sequences that perform thesame biological activity, namely raising serum calcium and renalphosphorus excretion, and lowering serum phosphorus and renal calciumexcretion. Preferably, PTH polypeptide homologs may be defined aspolypeptides exhibiting at least 40%, 50%, 60%, 70%, 80%, 90% or 95%identity to a reference PTH or PTHrP polypeptide, preferably the PTHpolypeptide of SEQ ID NO:51.

Thus, a PTH polypeptide according to the invention may be, for example:(i) one in which at least one of the amino acids residues is substitutedwith a conserved or non-conserved amino acid residue, preferably aconserved amino acid residue, and such substituted amino acid residuemay or may not be one encoded by the genetic code; and/or (ii) one inwhich at least one of the amino acid residues includes a substituentgroup; and/or (iii) one in which the PTH polypeptide is fused withanother compound, such as a compound to increase the half-life of thepolypeptide (for example, polyethylene glycol); and/or (iv) one in whichadditional amino acids are fused to the PTH polypeptide, such as an IgGFc fusion region polypeptide or leader or secretory sequence or asequence which is employed for purification of the above form of thepolypeptide or a pre-protein sequence.

As used herein, the term “PTH polypeptide fragment” refers to anypolypeptide comprising a contiguous span of a part of the amino acidsequence of a PTH or PTHrP polypeptide, preferably the polypeptide ofSEQ ID NO:51.

More specifically, a PTH polypeptide fragment comprises at least 6, suchas at least 8, at least 10 or at least 17 consecutive amino acids of aPTH or PTHrP polypeptide, more preferably of the polypeptide of SEQ IDNO:51. A PTH polypeptide fragment may additionally be described assub-genuses of PTH or PTHrP polypeptides comprising at least 6 aminoacids, wherein “at least 6” is defined as any integer between 6 and theinteger representing the C-terminal amino acid of a PTH or PTHrPpolypeptide, preferably of the polypeptide of SEQ ID No:51. Furtherincluded are species of PTH or PTHrP polypeptide fragments at least 6amino acids in length, as described above, that are further specified interms of their N-terminal and C-terminal positions. Also encompassed bythe term “PTH polypeptide fragment” as individual species are all PTH orPTHrP polypeptide fragments, at least 6 amino acids in length, asdescribed above, that may be particularly specified by a N-terminal andC-terminal position. That is, every combination of a N-terminal andC-terminal position that a fragment at least 6 contiguous amino acidresidues in length could occupy, on any given amino acid sequence of aPTH or PTHrP polypeptide, preferably the PTH polypeptide of SEQ ID:NO51,is included in the present invention.

The term “PTH” also includes poly(amino acid) conjugates which have asequence as described above, but having a backbone that comprises bothamide and non-amide linkages, such as ester linkages, like for exampledepsipeptides. Depsipeptides are chains of amino acid residues in whichthe backbone comprises both amide (peptide) and ester bonds.Accordingly, the term “side chain” as used herein refers either to themoiety attached to the alpha-carbon of an amino acid moiety, if theamino acid moiety is connected through amine bonds such as inpolypeptides, or to any carbon atom-comprising moiety attached to thebackbone of a poly(amino acid) conjugate, such as for example in thecase of depsipeptides. Preferably, the term “PTH” refers to polypeptideshaving a backbone formed through amide (peptide) bonds.

As the term PTH includes the above-described variants, analogs,orthologs, homologs, derivatives and fragments of PTH and PTHrP, allreferences to specific positions within a reference sequence alsoinclude the equivalent positions in variants, analogs, orthologs,homologs, derivatives and fragments of a PTH or PTHrP moiety, even ifnot specifically mentioned.

As used herein the term “micelle” means an aggregate of amphiphilicmolecules dispersed in a liquid colloid. In aqueous solution a typicalmicelle forms an aggregate with the hydrophilic moiety of the surfactantmolecules facing the surrounding solvent and the hydrophobic moiety ofthe surfactant molecule facing inwards, also called “normal-phasemicelle”. “Invers micelles” have the hydrophilic moiety facing inwardsand the hydrophobic moiety facing the surrounding solvent.

As used herein the term “liposome” refers to a vesicle, preferably aspherical vesicle, having at least one lipid bilayer. Preferably,liposomes comprise phospholipids, even more preferablyphosphatidylcholine. The term “liposome” refers to various structuresand sizes, such as, for example, to multilamellar liposome vesicles(MLV) having more than one concentric lipid bilayer with an averagediameter of 100 to 1000 nm, small unilamellar liposome vesicles (SUV)having one lipid bilayer and an average diameter of 25 to 100 nm, largeunilamellar liposome vesicles (LUV) having one lipid bilayer and anaverage diameter of about 1000 m and giant unilamellar vesicles (GUV)having one lipid bilayer and an average diameter of 1 to 100 μm. Theterm “liposome” also includes elastic vesicles such as transferosomesand ethosomes, for example.

As used herein the term “aquasome” refers to spherical nanoparticleshaving a diameter of 60 to 300 nm that comprise at least three layers ofself-assembled structure, namely a solid phase nanocrystalline corecoated with an oligomeric film to which drug molecules are adsorbed withor without modification of the drug.

As used herein the term “ethosome” refers to lipid vesicles comprisingphospholipids and ethanol and/or isopropanol in relatively highconcentration and water, having a size ranging from tens of nanometersto micrometers.

As used herein the term “LeciPlex” refers to positively chargedphospholipid-based vesicular system which comprises soy PC, a cationicagent, and a bio-compatible solvent like PEG 300, PEG 400, diethyleneglycol monoethyl ether, tetrahydrofurfuryl alcohol polyethylene glycolether or 2-pyrrolidoneor N-methyl-2-pyrrolidone.

As used herein the term “niosome” refers to unilamellar or multilamellarvesicles comprising non-ionic surfactants.

As used herein the term “pharmacosome” refers to ultrafine vesicular,micellar or hexagonal aggregates from lipids covalently bound tobiologically active moieties.

As used herein the term “proniosome” refers to dry formulations ofsurfactant-coated carrier which on rehydration and mild agitation givesniosomes.

As used herein the term “polymersome” refers to an artificial sphericalvesicle comprising a membrane formed from amphiphilic synthetic blockcopolymers and may optionally comprise an aqueous solution in its core.A polymersome has a diameter ranging from 50 nm to 5 gtm and larger. Theterm also includes syntosomes, which are polymersomes engineered tocomprise channels that allow certain chemicals to pass through themembrane into or out of the vesicle.

As used herein the term “sphingosome” refers to a concentric, bilayeredvesicle in which an aqueous volume is entirely enclosed by a membranouslipid bilayer mainly composed of natural or synthetic sphingolipid.

As used herein the term “transferosome” refers to ultraflexible lipidvesicles comprising an aqueous core that are formed from a mixture ofcommon polar and suitable edge-activated lipids which facilitate theformation of highly curved bilayers which render the transferosomehighly deformable.

As used herein the term “ufasome” refers to a vesicle comprisingunsaturated fatty acids.

As used herein the term “polypeptide” refers to a peptide comprising upto and including 50 amino acid monomers.

As used herein the term “protein” refers to a peptide of more than 50amino acid residues.

Preferably a protein comprises at most 20000 amino acid residues, suchas at most 15000 amino acid residues, such as at most 10000 amino acidresidues, such as at most 5000 amino acid residues, such as at most 4000amino acid residues, such as at most 3000 amino acid residues, such asat most 2000 amino acid residues, such as at most 1000 amino acidresidues.

As used herein the term “physiological conditions” refers to an aqueousbuffer at pH 7.4, 37° C.

As used herein the term “pharmaceutical composition” refers to acomposition containing one or more active ingredients, such as forexample at least one controlled-release PTH compounds, and one or moreexcipients, as well as any product which results, directly orindirectly, from combination, complexation or aggregation of any two ormore of the ingredients of the composition, or from dissociation of oneor more of the ingredients, or from other types of reactions orinteractions of one or more of the ingredients. Accordingly, thepharmaceutical compositions of the present invention encompass anycomposition made by admixing one or more controlled-release PTH compoundand a pharmaceutically acceptable excipient.

As used herein the term “liquid composition” refers to a mixturecomprising water-soluble controlled-release PTH compound and one or moresolvents, such as water.

The term “suspension composition” relates to a mixture comprisingwater-insoluble controlled-release PTH compound and one or moresolvents, such as water.

As used herein, the term “dry composition” means that a pharmaceuticalcomposition is provided in a dry form. Suitable methods for drying arespray-drying and lyophilization, i.e. freeze-drying. Such drycomposition of prodrug has a residual water content of a maximum of 10%,preferably less than 5% and more preferably less than 2%, determinedaccording to Karl Fischer. Preferably, the pharmaceutical composition ofthe present invention is dried by lyophilization.

The term “drug” as used herein refers to a substance used in thetreatment, cure, prevention, or diagnosis of a disease or used tootherwise enhance physical or mental well-being. If a drug is conjugatedto another moiety, the moiety of the resulting product that originatedfrom the drug is referred to as “biologically active moiety”.

As used herein the term “prodrug” refers to a conjugate in which abiologically active moiety is reversibly and covalently connected to aspecialized protective group through a reversible linker moiety, alsoreferred to as “reversible prodrug linker moiety”, which comprises areversible linkage with the biologically active moiety and wherein thespecialized protective group alters or eliminates undesirable propertiesin the parent molecule. This also includes the enhancement of desirableproperties in the drug and the suppression of undesirable properties.The specialized non-toxic protective group is referred to as “carrier”.A prodrug releases the reversibly and covalently bound biologicallyactive moiety in the form of its corresponding drug. In other words, aprodrug is a conjugate comprising a biologically active moiety which iscovalently and reversibly conjugated to a carrier moiety via areversible prodrug linker moiety, which covalent and reversibleconjugation of the carrier to the reversible prodrug linker moiety iseither directly or through a spacer. Such conjugate releases theformerly conjugated biologically active moiety in the form of a freeunmodified drug.

A “biodegradable linkage” or a “reversible linkage” is a linkage that ishydrolytically degradable, i.e. cleavable, in the absence of enzymesunder physiological conditions (aqueous buffer at pH 7.4, 37° C.) with ahalf-life ranging from one hour to three months, preferably from onehour to two months, even more preferably from one hour to one month,even more preferably from one hour to three weeks, most preferably fromone hour to two weeks. Accordingly, a stable linkage is a linkage havinga half-life under physiological conditions (aqueous buffer at pH 7.4,37° C.) of more than three months.

As used herein, the term “traceless prodrug linker” means a reversibleprodrug linker, i.e. a linker moiety reversibly and covalentlyconnecting the biologically active moiety with the carrier, which uponcleavage releases the drug in its free form. As used herein, the term“free form” of a drug means the drug in its unmodified,pharmacologically active form.

As used herein, the term “excipient” refers to a diluent, adjuvant, orvehicle with which the therapeutic, such as a drug or prodrug, isadministered. Such pharmaceutical excipient can be sterile liquids, suchas water and oils, including those of petroleum, animal, vegetable orsynthetic origin, including but not limited to peanut oil, soybean oil,mineral oil, sesame oil and the like. Water is a preferred excipientwhen the pharmaceutical composition is administered orally. Saline andaqueous dextrose are preferred excipients when the pharmaceuticalcomposition is administered intravenously. Saline solutions and aqueousdextrose and glycerol solutions are preferably employed as liquidexcipients for injectable solutions. Suitable pharmaceutical excipientsinclude starch, glucose, lactose, sucrose, mannitol, trehalose, gelatin,malt, rice, flour, chalk, silica gel, sodium stearate, glycerolmonostearate, talc, sodium chloride, dried skim milk, glycerol,propylene, glycol, water, ethanol and the like. The pharmaceuticalcomposition, if desired, can also contain minor amounts of wetting oremulsifying agents, pH buffering agents, like, for example, acetate,succinate, tris, carbonate, phosphate, HEPES(4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid), MES(2-(N-morpholino)ethanesulfonic acid), or can contain detergents, likeTween, poloxamers, poloxamines, CHAPS, Igepal, or amino acids like, forexample, glycine, lysine, or histidine. These pharmaceuticalcompositions can take the form of solutions, suspensions, emulsions,tablets, pills, capsules, powders, sustained-release formulations andthe like. The pharmaceutical composition can be formulated as asuppository, with traditional binders and excipients such astriglycerides. Oral formulation can include standard excipients such aspharmaceutical grades of mannitol, lactose, starch, magnesium stearate,sodium saccharine, cellulose, magnesium carbonate, etc. Suchcompositions will contain a therapeutically effective amount of the drugor biologically active moiety, together with a suitable amount ofexcipient so as to provide the form for proper administration to thepatient. The formulation should suit the mode of administration.

As used herein, the term “reagent” means a chemical compound whichcomprises at least one functional group for reaction with the functionalgroup of another chemical compound or drug. It is understood that a drugcomprising a functional group (such as a primary or secondary amine orhydroxyl functional group) is also a reagent.

As used herein, the term “moiety” means a part of a molecule, whichlacks one or more atom(s) compared to the corresponding reagent. If, forexample, a reagent of the formula “H—X—H” reacts with another reagentand becomes part of the reaction product, the corresponding moiety ofthe reaction product has the structure “H—X—” or “—X—”, whereas each “—”indicates attachment to another moiety. Accordingly, a biologicallyactive moiety is released from a prodrug as a drug.

It is understood that if the sequence or chemical structure of a groupof atoms is provided which group of atoms is attached to two moieties oris interrupting a moiety, said sequence or chemical structure can beattached to the two moieties in either orientation, unless explicitlystated otherwise. For example, a moiety “—C(O)N(R¹)—” can be attached totwo moieties or interrupting a moiety either as “—C(O)N(R¹)—” or as“—N(R¹)C(O)—”. Similarly, a moiety

can be attached to two moieties or can interrupt a moiety either as

As used herein, the term “functional group” means a group of atoms whichcan react with other groups of atoms. Functional groups include but arenot limited to the following groups: carboxylic acid (—(C═O)OH), primaryor secondary amine (—NH₂, —NH—), maleimide, thiol (—SH), sulfonic acid(—(O═S═O)OH), carbonate, carbamate (—O(C═O)N<), hydroxyl (—OH), aldehyde(—(C═O)H), ketone (—(C═O)—), hydrazine (>N—N<), isocyanate,isothiocyanate, phosphoric acid (—O(P═O)OHOH), phosphonic acid(—O(P═O)OHH), haloacetyl, alkyl halide, acryloyl, aryl fluoride,hydroxylamine, disulfide, sulfonamides, sulfuric acid, vinyl sulfone,vinyl ketone, diazoalkane, oxirane, and aziridine.

In case the controlled-release PTH compound of the present inventioncomprise one or more acidic or basic groups, the invention alsocomprises their corresponding pharmaceutically or toxicologicallyacceptable salts, in particular their pharmaceutically utilizable salts.Thus, the controlled-release PTH compound of the present inventioncomprising acidic groups can be used according to the invention, forexample, as alkali metal salts, alkaline earth metal salts or asammonium salts. More precise examples of such salts include sodiumsalts, potassium salts, calcium salts, magnesium salts or salts withammonia or organic amines such as, for example, ethylamine,ethanolamine, triethanolamine or amino acids. Controlled-release PTHcompound of the present invention comprising one or more basic groups,i.e. means a group of atoms which can be protonated, can be present andcan be used according to the invention in the form of their additionsalts with inorganic or organic acids. Examples for suitable acidsinclude hydrogen chloride, hydrogen bromide, phosphoric acid, sulfuricacid, nitric acid, methanesulfonic acid, p-toluenesulfonic acid,naphthalenedisulfonic acids, oxalic acid, acetic acid, tartaric acid,lactic acid, salicylic acid, benzoic acid, formic acid, propionic acid,pivalic acid, tartaric acid, lactic acid, salicylic acid, benzoic acid,formic acid, propionic acid, pivalic acid, diethylacetic acid, malonicacid, succinic acid, pimelic acid, fumaric acid, maleic acid, malicacid, sulfaminic acid, phenylpropionic acid, gluconic acid, ascorbicacid, isonicotinic acid, citric acid, adipic acid, and other acids knownto the person skilled in the art. For the person skilled in the artfurther methods are known for converting the basic group into a cationlike the alkylation of an amine group resulting in a positively-chargeammonium group and an appropriate counterion of the salt. If thecontrolled-release PTH compound of the present invention simultaneouslycomprise acidic and basic groups, the invention also includes, inaddition to the salt forms mentioned, inner salts or betaines(zwitterions). The respective salts can be obtained by customary methodswhich are known to the person skilled in the art like, for example bycontacting these compounds with an organic or inorganic acid or base ina solvent or dispersant, or by anion exchange or cation exchange withother salts. The present invention also includes all salts of thecompounds of the present invention which, owing to low physiologicalcompatibility, are not directly suitable for use in pharmaceuticals butwhich can be used, for example, as intermediates for chemical reactionsor for the preparation of pharmaceutically acceptable salts.

The term “pharmaceutically acceptable” means a substance that does causeharm when administered to a patient and preferably means approved by aregulatory agency, such as the EMA (Europe) and/or the FDA (US) and/orany other national regulatory agency for use in animals, preferably foruse in humans.

As used herein the term “about” in combination with a numerical value isused to indicate a range ranging from and including the numerical valueplus and minus no more than 10% of said numerical value, more preferablyno more than 8% of said numerical value, even more preferably no morethan 5% of said numerical value and most preferably no more than 2% ofsaid numerical value. For example, the phrase “about 200” is used tomean a range ranging from and including 200+/−10%, i.e. ranging from andincluding 180 to 220; preferably 200+/−8%, i.e. ranging from andincluding 184 to 216; even more preferably ranging from and including200+/−5%, i.e. ranging from and including 190 to 210; and mostpreferably 200+/−2%, i.e. ranging from and including 196 to 204. It isunderstood that a percentage given as “about 20%” does not mean“20%+/−10%”, i.e. ranging from and including 10 to 30%, but “about 20%”means ranging from and including 18 to 22%, i.e. plus and minus 10% ofthe numerical value which is 20.

As used herein, the term “polymer” means a molecule comprising repeatingstructural units, i.e. the monomers, connected by chemical bonds in alinear, circular, branched, crosslinked or dendrimeric way or acombination thereof, which may be of synthetic or biological origin or acombination of both. It is understood that a polymer may also compriseone or more other chemical groups and/or moieties, such as, for example,one or more functional groups. Preferably, a soluble polymer has amolecular weight of at least 0.5 kDa, e.g. a molecular weight of atleast 1 kDa, a molecular weight of at least 2 kDa, a molecular weight ofat least 3 kDa or a molecular weight of at least 5 kDa. If the polymeris soluble, it preferable has a molecular weight of at most 1000 kDa,such as at most 750 kDa, such as at most 500 kDa, such as at most 300kDa, such as at most 200 kDa, such as at most 100 kDa. It is understoodthat for insoluble polymers, such as hydrogels, no meaningful molecularweight ranges can be provided. It is understood that also a protein is apolymer in which the amino acids are the repeating structural units,even though the side chains of each amino acid may be different.

As used herein, the term “polymeric” means a reagent or a moietycomprising one or more polymers or polymer moieties. A polymeric reagentor moiety may optionally also comprise one or more othermoiety/moieties, which are preferably selected from the group consistingof:

-   -   C₁₋₅₀ alkyl, C₂₋₅₀ alkenyl, C₂₋₅₀ alkynyl, C₃₋₁₀ cycloalkyl, 3-        to 10-membered heterocyclyl, 8- to 11-membered heterobicyclyl,        phenyl, naphthyl, indenyl, indanyl, and tetralinyl; and    -   linkages selected from the group comprising

-   -   wherein        -   dashed lines indicate attachment to the remainder of the            moiety or reagent, and        -   —R and —R^(a) are independently of each other selected from            the group consisting of —H, methyl, ethyl, propyl, butyl,            pentyl and hexyl.

The person skilled in the art understands that the polymerizationproducts obtained from a polymerization reaction do not all have thesame molecular weight, but rather exhibit a molecular weightdistribution. Consequently, the molecular weight ranges, molecularweights, ranges of numbers of monomers in a polymer and numbers ofmonomers in a polymer as used herein, refer to the number averagemolecular weight and number average of monomers, i.e. to the arithmeticmean of the molecular weight of the polymer or polymeric moiety and thearithmetic mean of the number of monomers of the polymer or polymericmoiety.

Accordingly, in a polymeric moiety comprising “x” monomer units anyinteger given for “x” therefore corresponds to the arithmetic meannumber of monomers. Any range of integers given for “x” provides therange of integers in which the arithmetic mean numbers of monomers lies.An integer for “x” given as “about x” means that the arithmetic meannumbers of monomers lies in a range of integers of x+/−10%, preferablyx+/−8%, more preferably x+/−5% and most preferably x+/−2%.

As used herein, the term “number average molecular weight” means theordinary arithmetic mean of the molecular weights of the individualpolymers.

As used herein the term “water-soluble” with reference to a carriermeans that when such carrier is part of the controlled-release PTHcompound of the present invention at least 1 g of the controlled-releasePTH compound comprising such water-soluble carrier can be dissolved inone liter of water at 20° C. to form a homogeneous solution.Accordingly, the term “water-insoluble” with reference to a carriermeans that when such carrier is part of a controlled-release PTHcompound of the present invention less than 1 g of thecontrolled-release PTH compound comprising such water-insoluble carriercan be dissolved in one liter of water at 20° C. to form a homogeneoussolution.

As used herein, the term “hydrogel” means a hydrophilic or amphiphilicpolymeric network composed of homopolymers or copolymers, which isinsoluble due to the presence of covalent chemical crosslinks. Thecrosslinks provide the network structure and physical integrity.

As used herein the term “thermogelling” means a compound that is aliquid or a low viscosity solution having a viscosity of less than 500cps at 25° C. at a shear rate of about 0.1/second at a low temperature,which low temperature ranges between about 0° C. to about 10° C., butwhich is a higher viscosity compound of less than 10000 cps at 25° C. ata shear rate of about 0.1/second at a higher temperature, which highertemperature ranges between about 30° C. to about 40° C., such as atabout 37° C.

As used herein, the term “PEG-based” in relation to a moiety or reagentmeans that said moiety or reagent comprises PEG. Preferably, a PEG-basedmoiety or reagent comprises at least 10% (w/w) PEG, such as at least 20%(w/w) PEG, such as at least 30% (w/w) PEG, such as at least 40% (w/w)PEG, such as at least 50% (w/w), such as at least 60 (w/w) PEG, such asat least 70% (w/w) PEG, such as at least 80% (w/w) PEG, such as at least90% (w/w) PEG, such as at least 95%. The remaining weight percentage ofthe PEG-based moiety or reagent are other moieties preferably selectedfrom the following moieties and linkages:

-   -   C₁₋₅₀ alkyl, C₂₋₅₀ alkenyl, C₂₋₅₀ alkynyl, C₃₋₁₀ cycloalkyl, 3-        to 10-membered heterocyclyl, 8- to 11-membered heterobicyclyl,        phenyl, naphthyl, indenyl, indanyl, and tetralinyl; and    -   linkages selected from the group comprising

-   -   wherein        -   dashed lines indicate attachment to the remainder of the            moiety or reagent, and        -   —R and —R^(a) are independently of each other selected from            the group consisting of —H, methyl, ethyl, propyl, butyl,            pentyl and hexyl.

As used herein, the term “PEG-based comprising at least X % PEG” inrelation to a moiety or reagent means that said moiety or reagentcomprises at least X % (w/w) ethylene glycol units (—CH₂CH₂O—), whereinthe ethylene glycol units may be arranged blockwise, alternating or maybe randomly distributed within the moiety or reagent and preferably allethylene glycol units of said moiety or reagent are present in oneblock; the remaining weight percentage of the PEG-based moiety orreagent are other moieties preferably selected from the followingmoieties and linkages:

-   -   C₁₋₅₀ alkyl, C₂₋₅₀ alkenyl, C₂₋₅₀ alkynyl, C₃₋₁₀ cycloalkyl, 3-        to 10-membered heterocyclyl, 8- to 11-membered heterobicyclyl,        phenyl, naphthyl, indenyl, indanyl, and tetralinyl; and    -   linkages selected from the group comprising

-   -   wherein        -   dashed lines indicate attachment to the remainder of the            moiety or reagent, and        -   —R and —R^(a) are independently of each other selected from            the group consisting of —H, methyl, ethyl, propyl, butyl,            pentyl and hexyl.

The term “hyaluronic acid-based comprising at least X % hyaluronic acid”is used accordingly.

The term “substituted” as used herein means that one or more —H atom(s)of a molecule or moiety are replaced by a different atom or a group ofatoms, which are referred to as “substituent”.

Preferably, the one or more further optional substituents areindependently of each other selected from the group consisting ofhalogen, —CN, —COOR^(x1), —OR^(x1), —C(O)R^(x1), —C(O)N(R^(x1)R^(x1a)),—S(O)₂N(R^(x1)R^(x1a)), —S(O)N(R^(x1)R^(x1a)), —S(O)₂R^(x1),—S(O)R^(x1), —N(R^(x1))S(O)₂N(R^(x1a)R^(x1b)), —SR^(x1),—N(R^(x1)R^(x1a)), —NO₂, —OC(O)R^(x1), —N(R^(x1))C(O)R^(x1a),—N(R^(x1))S(O)₂R^(x1a), —N(R^(x1))S(O)R^(x1a), —N(R^(x1))C(O)OR^(x1a),—N(R^(x1))C(O)N(R^(x1a)R^(x1b)), —OC(O)N(R^(x1)R^(x1a)), -T⁰, C₁₋₅₀alkyl, C₂₋₅₀ alkenyl, and C₂₋₅₀ alkynyl; wherein -T⁰, C₁₋₅₀ alkyl, C₂₋₅₀alkenyl, and C₂₋₅₀ alkynyl are optionally substituted with one or more—R^(x2), which are the same or different and wherein C₁-C₅₀ alkyl, C₂₋₅₀alkenyl, and C₂₋₅₀ alkynyl are optionally interrupted by one or moregroups selected from the group consisting of -T⁰-, —C(O)O—, —O—, —C(O)—,—C(O)N(R^(x3))—, —S(O)₂N(R^(x3))—, —S(O)N(R^(x3))—, —S(O)₂—, —S(O)—,—N(R^(x3))S(O)₂N(R^(x3a))—, —S—, —N(R^(x3))—, —OC(OR^(x3))(R^(x3a))—,—N(R^(x3))C(O)N(R^(x3a))—, and —OC(O)N(R^(x3))—;

—R^(x1), —R^(x1a), —R^(x1b) are independently of each other selectedfrom the group consisting of —H, -T⁰, C₁₋₅₀ alkyl, C₂₋₅₀ alkenyl, andC₂₋₅₀ alkynyl; wherein -T⁰, C₁₋₅₀ alkyl, C₂₋₅₀ alkenyl, and C₂₋₅₀alkynyl are optionally substituted with one or more —R^(x2), which arethe same or different and wherein C₁-C₅₀ alkyl, C₂₋₅₀ alkenyl, and C₂₋₅₀alkynyl are optionally interrupted by one or more groups selected fromthe group consisting of -T⁰-, —C(O)O—, —O—, —C(O)—, —C(O)N(R^(x3))—,—S(O)₂N(R^(x3))—, —S(O)N(R^(x3))—; —S(O)₂—, —S(O)—,—N(R^(x3))S(O)₂N(R^(x3a))—, —S—, —N(R^(x3))—, —OC(OR^(x3))(R^(x3a))—,—N(R^(x3))C(O)N(R^(x3a))—, and —OC(O)N(R^(x3))—;

each T⁰ is independently selected from the group consisting of phenyl,naphthyl, indenyl, indanyl, tetralinyl, C₃₋₁₀ cycloalkyl, 3- to10-membered heterocyclyl, and 8- to 11-membered heterobicyclyl; whereineach T⁰ is independently optionally substituted with one or more—R^(x2), which are the same or different;

each —R^(x2) is independently selected from the group consisting ofhalogen, —CN, oxo (═O), —COOR^(x4), —OR^(x4), —C(O)R^(x4),—C(O)N(R^(x4)R^(x4a)), —S(O)₂N(R^(x4)R^(x4a)), —S(O)N(R^(x4)R^(x4a)),—S(O)₂R^(x4), —S(O)R^(x4), —N(R^(x4))S(O)₂N(R^(x4a)R^(x4b)), —SR^(x4),—N(R^(x4)R^(x4a)), —NO₂, —OC(O)R^(x4), —N(R^(x4))C(O)R^(x4a),—N(R^(x4))S(O)₂R^(x4a), —N(R^(x4))S(O)R^(x4a), —N(R^(x4))C(O)OR^(x4a),—N(R^(x4))C(O)N(R^(x4a)R^(x4b)), —OC(O)N(R^(x4)R^(x4a)), and C₁₋₆ alkyl;wherein C₁₋₆ alkyl is optionally substituted with one or more halogen,which are the same or different;

each —R^(x3), —R^(x3a), —R^(x4), —R^(x4a), —R^(x4b) is independentlyselected from the group consisting of —H and C₁₋₆ alkyl; wherein C₁₋₆alkyl is optionally substituted with one or more halogen, which are thesame or different.

More preferably, the one or more further optional substituents areindependently of each other selected from the group consisting ofhalogen, —CN, —COOR^(x1), —OR^(x1), —C(O)R^(x1), —C(O)N(R^(x1)R^(x1a)),—S(O)₂N(R^(x1a)), —S(O)N(R^(x1)R^(x1a)), —S(O)₂R^(x1), —S(O)R^(x1),—N(R^(x1))S(O)₂N(R^(x1a)R^(x1b)), —SR^(x1), —N(R^(x1)R^(x1a)), —NO₂,—OC(O)R^(x1), —N(R^(x1))C(O)R^(x1a), —N(R^(x1))S(O)₂R^(x1a),—N(R^(x1))S(O)R^(x1a), —N(R^(x1))C(O)OR^(x1a),—N(R^(x1))C(O)N(R^(x1a)R^(x1b)), —OC(O)N(R^(x1)R^(x1a)), -T⁰, C₁₋₁₀alkyl, C₂₋₁₀ alkenyl, and C₂₋₁₀ alkynyl; wherein -T⁰, C₁₋₁₀ alkyl, C₂₋₁₀alkenyl, and C₂₋₁₀ alkynyl are optionally substituted with one or more—R^(x2), which are the same or different and wherein C₁₋₁₀ alkyl, C₂₋₁₀alkenyl, and C₂₋₁₀ alkynyl are optionally interrupted by one or moregroups selected from the group consisting of -T⁰-, —C(O)O—, —O—, —C(O)—,—C(O)N(R^(x3))—, —S(O)₂N(R^(x3))—, —S(O)N(R^(x3))—, —S(O)₂—, —S(O)—,—N(R^(x3))S(O)₂N(R^(x3a))—, —S—, —N(R^(x3))—, —OC(OR^(x3))(R^(x3a))—,—N(R^(x3))C(O)N(R^(x3a))—, and —OC(O)N(R^(x3))—;

-   -   each —R^(x1), —R^(x1a), —R^(x1b), —R^(x3), —R^(x3a) is        independently selected from the group consisting of —H, halogen,        C₁₋₆ alkyl, C₂₋₆ alkenyl, and C₂₋₆ alkynyl;    -   each T⁰ is independently selected from the group consisting of        phenyl, naphthyl, indenyl, indanyl, tetralinyl, C₃₋₁₀        cycloalkyl, 3- to 10-membered heterocyclyl, and 8- to        11-membered heterobicyclyl; wherein each T⁰ is independently        optionally substituted with one or more —R^(x2), which are the        same or different;    -   each —R^(x2) is independently selected from the group consisting        of halogen, —CN, oxo (═O), —COOR^(x4), —OR^(x4), —C(O)R^(x4),        —C(O)N(R^(x4)R^(x4a)), —S(O)₂N(R^(x4)R^(x4a)),        —S(O)N(R^(x4)R^(x4a)), —S(O)₂R^(x4), —S(O)R^(x4),        —N(R^(x4))S(O)₂N(R^(x4a)R^(x4b)), —SR^(x4), —N(R^(x4)R^(x4a)),        —NO₂, —OC(O)R^(x4), —N(R^(x4))C(O)R^(x4a),        —N(R^(x4))S(O)₂R^(x4a), —N(R^(x4))S(O)R^(x4a),        —N(R^(x4))C(O)OR^(x4a), —N(R^(x4))C(O)N(R^(x4a)R^(x4b)),        —OC(O)N(R^(x4)R^(x4a)), and C₁₋₆ alkyl; wherein C₁₋₆ alkyl is        optionally substituted with one or more halogen, which are the        same or different;

each —R^(x4), —R^(x4a), —R^(x4b) is independently selected from thegroup consisting of —H, halogen, C₁₋₆ alkyl, C₂₋₆ alkenyl, and C₂₋₆alkynyl;

Even more preferably, the one or more further optional substituents areindependently of each other selected from the group consisting ofhalogen, —CN, —COOR^(x1), —OR^(x1), —C(O)R^(x1), —C(O)N(R^(x1)R^(x1a)),—S(O)₂N(R^(x1)R^(x1a)), —S(O)N(R^(x1)R^(x1a)), —S(O)₂R^(x1),—S(O)R^(x1), —N(R^(x1))S(O)₂N(R^(x1a)R^(x1b)), —SR^(x1),—N(R^(x1)R^(x1a)), —NO₂, —OC(O)R^(x1), —N(R^(x1))C(O)R^(x1a),—N(R^(x1))S(O)₂R^(x1a), —N(R^(x1))S(O)R^(x1a), —N(R^(x1))C(O)OR^(x1a),—N(R^(x1))C(O)N(R^(x1a)R^(x1b)), —OC(O)N(R^(x1)R^(x1a)), -T⁰, C₁₋₆alkyl, C₂₋₆ alkenyl, and C₂₋₆ alkynyl; wherein -T⁰, C₁₋₆ alkyl, C₂₋₆alkenyl, and C₂₋₆ alkynyl are optionally substituted with one or more—R^(x2), which are the same or different and wherein C₁₋₆ alkyl, C₂₋₆alkenyl, and C₂₋₆ alkynyl are optionally interrupted by one or moregroups selected from the group consisting of -T₀-, —C(O)O—, —O—, —C(O)—,—C(O)N(R^(x3))—, —S(O)₂N(R^(x3))—, —S(O)N(R^(x3))—, —S(O)₂—, —S(O)—,—N(R^(x3))S(O)₂N(R^(x3a))—, —S—, —N(R^(x3))—, —OC(OR^(x3))(R^(x3a))—,—N(R^(x3))C(O)N(R^(x3a))—, and —OC(O)N(R^(x3))—;

each —R^(x1), —R^(x1a), —R^(x1b), —R^(x2), —R^(x3), —R^(x3a) isindependently selected from the group consisting of —H, halogen, C₁₋₆alkyl, C₂₋₆ alkenyl, and C₂₋₆ alkynyl;

each T⁰ is independently selected from the group consisting of phenyl,naphthyl, indenyl, indanyl, tetralinyl, C₃₋₁₀ cycloalkyl, 3- to10-membered heterocyclyl, and 8- to 11-membered heterobicyclyl; whereineach T⁰ is independently optionally substituted with one or more—R^(x2), which are the same or different.

Preferably, a maximum of 6-H atoms of an optionally substituted moleculeare independently replaced by a substituent, e.g. 5-H atoms areindependently replaced by a substituent, 4-H atoms are independentlyreplaced by a substituent, 3-H atoms are independently replaced by asubstituent, 2-H atoms are independently replaced by a substituent, or1-H atom is replaced by a substituent.

The term “interrupted” means that a moiety is inserted between twocarbon atoms or—if the insertion is at one of the moiety's ends—betweena carbon or heteroatom and a hydrogen atom, preferably between a carbonand a hydrogen atom.

As used herein, the term “C₁₋₄ alkyl” alone or in combination means astraight-chain or branched alkyl moiety having 1 to 4 carbon atoms. Ifpresent at the end of a molecule, examples of straight-chain or branchedC₁₋₄ alkyl are methyl, ethyl, n-propyl, isopropyl, n-butyl, isobutyl,sec-butyl and tert-butyl. When two moieties of a molecule are linked bythe C₁₋₄ alkyl, then examples for such C₁₋₄ alkyl groups are —CH₂—,—CH₂—CH₂—, —CH(CH₃)—, —CH₂—CH₂—CH₂—, —CH(C₂H₅)—, —C(CH₃)₂—. Eachhydrogen of a C₁₋₄ alkyl carbon may optionally be replaced by asubstituent as defined above. Optionally, a C₁₋₄ alkyl may beinterrupted by one or more moieties as defined below.

As used herein, the term “C₁₋₆ alkyl” alone or in combination means astraight-chain or branched alkyl moiety having 1 to 6 carbon atoms. Ifpresent at the end of a molecule, examples of straight-chain andbranched C₁₋₆ alkyl groups are methyl, ethyl, n-propyl, isopropyl,n-butyl, isobutyl, sec-butyl, tert-butyl, n-pentyl, 2-methylbutyl,2,2-dimethylpropyl, n-hexyl, 2-methylpentyl, 3-methylpentyl,2,2-dimethylbutyl, 2,3-dimethylbutyl and 3,3-dimethylpropyl. When twomoieties of a molecule are linked by the C₁₋₆ alkyl group, then examplesfor such C₁₋₆ alkyl groups are —CH₂—, —CH₂—CH₂—, —CH(CH₃)—,—CH₂—CH₂—CH₂—, —CH(C₂H₅)— and —C(CH₃)₂—. Each hydrogen atom of a C₁₋₆carbon may optionally be replaced by a substituent as defined above.Optionally, a C₁₋₆ alkyl may be interrupted by one or more moieties asdefined below.

Accordingly, “C₁₋₁₀ alkyl”, “C₁₋₂₀ alkyl” or “C₁₋₅₀ alkyl” means analkyl chain having 1 to 10, 1 to 20 or 1 to 50 carbon atoms,respectively, wherein each hydrogen atom of the C₁₋₁₀, C₁-20 or C₁₋₅₀carbon may optionally be replaced by a substituent as defined above.Optionally, a C₁₋₁₀ or C₁₋₅₀ alkyl may be interrupted by one or moremoieties as defined below.

As used herein, the term “C₂₋₆ alkenyl” alone or in combination means astraight-chain or branched hydrocarbon moiety comprising at least onecarbon-carbon double bond having 2 to 6 carbon atoms. If present at theend of a molecule, examples are —CH═CH₂, —CH═CH—CH₃, —CH₂—CH═CH₂,—CH═CHCH₂—CH₃ and —CH═CH—CH═CH₂. When two moieties of a molecule arelinked by the C₂₋₆ alkenyl group, then an example for such C₂₋₆ alkenylis —CH═CH—. Each hydrogen atom of a C₂₋₆ alkenyl moiety may optionallybe replaced by a substituent as defined above. Optionally, a C₂₋₆alkenyl may be interrupted by one or more moieties as defined below.

Accordingly, the term “C₂₋₁₀ alkenyl”, “C₂₋₂₀ alkenyl” or “C₂₋₅₀alkenyl” alone or in combination means a straight-chain or branchedhydrocarbon moiety comprising at least one carbon-carbon double bondhaving 2 to 10, 2 to 20 or 2 to 50 carbon atoms. Each hydrogen atom of aC₂₋₁₀ alkenyl, C₂₋₂₀ alkenyl or C₂₋₅₀ alkenyl group may optionally bereplaced by a substituent as defined above. Optionally, a C₂₋₁₀ alkenyl,C₂₋₂₀ alkenyl or C₂₋₅₀ alkenyl may be interrupted by one or moremoieties as defined below.

As used herein, the term “C₂₋₆ alkynyl” alone or in combination meansstraight-chain or branched hydrocarbon moiety comprising at least onecarbon-carbon triple bond having 2 to 6 carbon atoms. If present at theend of a molecule, examples are —C≡CH, —CH₂—C≡CH, CH₂—CH₂—C≡CH andCH₂—C≡C—CH₃. When two moieties of a molecule are linked by the alkynylgroup, then an example is —C≡C—. Each hydrogen atom of a C₂₋₆ alkynylgroup may optionally be replaced by a substituent as defined above.Optionally, one or more double bond(s) may occur. Optionally, a C₂₋₆alkynyl may be interrupted by one or more moieties as defined below.

Accordingly, as used herein, the term “C₂₋₁₀ alkynyl”, “C₂₋₂₀ alkynyl”and “C₂₋₅₀ alkynyl” alone or in combination means a straight-chain orbranched hydrocarbon moiety comprising at least one carbon-carbon triplebond having 2 to 10, 2 to 20 or 2 to 50 carbon atoms, respectively. Eachhydrogen atom of a C₂₋₁₀ alkynyl, C₂₋₂₀ alkynyl or C₂₋₅₀ alkynyl groupmay optionally be replaced by a substituent as defined above.Optionally, one or more double bond(s) may occur. Optionally, a C₂₋₁₀alkynyl, C₂₋₂₀ alkynyl or C₂₋₅₀ alkynyl may be interrupted by one ormore moieties as defined below.

As mentioned above, a C₁₋₄ alkyl, C₁₋₆ alkyl, C₁₋₁₀ alkyl, C₁₋₂₀ alkyl,C₁₋₅₀ alkyl, C₂₋₆ alkenyl, C₂₋₁₀ alkenyl, C₂₋₂₀ alkenyl, C₂₋₅₀ alkenyl,C₂₋₆ alkynyl, C₂₋₁₀ alkynyl, C₂₋₂₀ alkenyl or C₂₋₅₀ alkynyl mayoptionally be interrupted by one or more moieties which are preferablyselected from the group consisting of

-   -   wherein    -   dashed lines indicate attachment to the remainder of the moiety        or reagent; and —R and —R^(a) are independently of each other        selected from the group consisting of —H, methyl, ethyl, propyl,        butyl, pentyl and hexyl.

As used herein, the term “C₃₋₁₀ cycloalkyl” means a cyclic alkyl chainhaving 3 to 10 carbon atoms, which may be saturated or unsaturated, e.g.cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cyclohexenyl,cycloheptyl, cyclooctyl, cyclononyl or cyclodecyl. Each hydrogen atom ofa C₃₋₁₀ cycloalkyl carbon may be replaced by a substituent as definedabove. The term “C₃₋₁₀ cycloalkyl” also includes bridged bicycles likenorbornane or norbornene.

The term “8- to 30-membered carbopolycyclyl” or “8- to 30-memberedcarbopolycycle” means a cyclic moiety of two or more rings with 8 to 30ring atoms, where two neighboring rings share at least one ring atom andthat may contain up to the maximum number of double bonds (aromatic ornon-aromatic ring which is fully, partially or un-saturated). Preferablya 8- to 30-membered carbopolycyclyl means a cyclic moiety of two, three,four or five rings, more preferably of two, three or four rings.

As used herein, the term “3- to 10-membered heterocyclyl” or “3- to10-membered heterocycle” means a ring with 3, 4, 5, 6, 7, 8, 9 or 10ring atoms that may contain up to the maximum number of double bonds(aromatic or non-aromatic ring which is fully, partially orun-saturated) wherein at least one ring atom up to 4 ring atoms arereplaced by a heteroatom selected from the group consisting of sulfur(including —S(O)—, —S(O)₂—), oxygen and nitrogen (including ═N(O)—) andwherein the ring is linked to the rest of the molecule via a carbon ornitrogen atom. Examples for 3- to 10-membered heterocycles include butare not limited to aziridine, oxirane, thiirane, azirine, oxirene,thiirene, azetidine, oxetane, thietane, furan, thiophene, pyrrole,pyrroline, imidazole, imidazoline, pyrazole, pyrazoline, oxazole,oxazoline, isoxazole, isoxazoline, thiazole, thiazoline, isothiazole,isothiazoline, thiadiazole, thiadiazoline, tetrahydrofuran,tetrahydrothiophene, pyrrolidine, imidazolidine, pyrazolidine,oxazolidine, isoxazolidine, thiazolidine, isothiazolidine,thiadiazolidine, sulfolane, pyran, dihydropyran, tetrahydropyran,imidazolidine, pyridine, pyridazine, pyrazine, pyrimidine, piperazine,piperidine, morpholine, tetrazole, triazole, triazolidine,tetrazolidine, diazepane, azepine and homopiperazine. Each hydrogen atomof a 3- to 10-membered heterocyclyl or 3- to 10-membered heterocyclicgroup may be replaced by a substituent as defined below.

As used herein, the term “8- to 11-membered heterobicyclyl” or “8- to11-membered heterobicycle” means a heterocyclic moiety of two rings with8 to 11 ring atoms, where at least one ring atom is shared by both ringsand that may contain up to the maximum number of double bonds (aromaticor non-aromatic ring which is fully, partially or un-saturated) whereinat least one ring atom up to 6 ring atoms are replaced by a heteroatomselected from the group consisting of sulfur (including —S(O)—,—S(O)₂—), oxygen and nitrogen (including ═N(O)—) and wherein the ring islinked to the rest of the molecule via a carbon or nitrogen atom.Examples for an 8- to 11-membered heterobicycle are indole, indoline,benzofuran, benzothiophene, benzoxazole, benzisoxazole, benzothiazole,benzisothiazole, benzimidazole, benzimidazoline, quinoline, quinazoline,dihydroquinazoline, quinoline, dihydroquinoline, tetrahydroquinoline,decahydroquinoline, isoquinoline, decahydroisoquinoline,tetrahydroisoquinoline, dihydroisoquinoline, benzazepine, purine andpteridine. The term 8- to 11-membered heterobicycle also includes spirostructures of two rings like 1,4-dioxa-8-azaspiro[4.5]decane or bridgedheterocycles like 8-aza-bicyclo[3.2.1]octane. Each hydrogen atom of an8- to 11-membered heterobicyclyl or 8- to 11-membered heterobicyclecarbon may be replaced by a substituent as defined below.

Similarly, the term “8- to 30-membered heteropolycyclyl” or “8- to30-membered heteropolycycle” means a heterocyclic moiety of more thantwo rings with 8 to 30 ring atoms, preferably of three, four or fiverings, where two neighboring rings share at least one ring atom and thatmay contain up to the maximum number of double bonds (aromatic ornon-aromatic ring which is fully, partially or unsaturated), wherein atleast one ring atom up to 10 ring atoms are replaced by a heteroatomselected from the group of sulfur (including —S(O)—, —S(O)₂—), oxygenand nitrogen (including ═N(O)—) and wherein the ring is linked to therest of a molecule via a carbon or nitrogen atom.

It is understood that the phrase “the pair R^(x)/R^(y) is joinedtogether with the atom to which they are attached to form a C₃₋₁₀cycloalkyl or a 3- to 10-membered heterocyclyl” in relation with amoiety of the structure

means that R^(x) and R^(y) form the following structure:

wherein R is C₃₋₁₀ cycloalkyl or 3- to 10-membered heterocyclyl.

It is also understood that the phrase “the pair R^(x)/R^(y) is jointtogether with the atoms to which they are attached to form a ring A” inrelation with a moiety of the structure

means that R^(x) and R^(y) form the following structure:

As used herein, “halogen” means fluoro, chloro, bromo or iodo. It isgenerally preferred that halogen is fluoro or chloro.

In general, the term “comprise” or “comprising” also encompasses“consist of” or “consisting of”.

Preferably, the pharmaceutical composition comprising acontrolled-release PTH compound is administered in accordance with adosage regimen in which dose adjustment in response to hypocalcemia orhypercalcemia is performed in increments of no more than 20%, morepreferably in increments of no more than 15% and most preferably inincrements of no more than 10%.

In on embodiment the pharmaceutical composition comprising acontrolled-release PTH compound is administered in accordance with adosage regimen in which dose adjustment in response to hypocalcemia orhypercalcemia is performed in increments of 25%.

More preferably, the pharmaceutical composition comprising acontrolled-release PTH compound is administered in accordance with adosage regimen in which dose adjustment in response to hypocalcemia orhypercalcemia is performed in increments of 20%.

Even more preferably, the pharmaceutical composition comprising acontrolled-release PTH compound is administered in accordance with adosage regimen in which dose adjustment in response to hypocalcemia orhypercalcemia is performed in increments of 15%.

Most preferably, the pharmaceutical composition comprising acontrolled-release PTH compound is administered in accordance with adosage regimen in which dose adjustment in response to hypocalcemia orhypercalcemia is performed in increments of 10%.

Preferably, the pharmaceutical comprising the controlled-release PTHcompound it administered to the patient no more often than once every 24hours, such as every 24 hours, every 36 hours, every 48 hours, every 60hours, every 72 hours, every 84 hours, every 96 hours, every 108 hours,every 120 hours, every 132 hours, every 144 hours, every 156 hours, oncea week, once every two weeks.

In one embodiment the pharmaceutical composition comprising thecontrolled-release PTH compound is administered every 24 hours.

In another embodiment the pharmaceutical composition comprising thecontrolled-release PTH compound is administered every 48 hours.

In another embodiment the pharmaceutical composition comprising thecontrolled-release PTH compound is administered every 72 hours.

In another embodiment the pharmaceutical composition comprising thecontrolled-release PTH compound is administered every 96 hours.

In another embodiment the pharmaceutical composition comprising thecontrolled-release PTH compound is administered every 120 hours.

In another embodiment the pharmaceutical composition comprising thecontrolled-release PTH compound is administered every 144 hours.

In another embodiment the pharmaceutical composition comprising thecontrolled-release PTH compound is administered once every week.

Preferably, the pharmaceutical composition comprising the PTH compoundis administered to a patient via subcutaneous administration, preferablyvia subcutaneous injection.

In one embodiment the pharmaceutical composition for use of the presentinvention is performed with a syringe. In another embodiment thepharmaceutical composition for use of the present invention isadministered with a pen injector. In another embodiment thepharmaceutical composition for use of the present invention isadministered with an auto injector.

Preferably, the controlled-release PTH compound comprises a PTH moleculeor moiety having the sequence of SEQ ID NO:47, SEQ ID NO:48, SEQ IDNO:49, SEQ ID NO:50, SEQ ID NO:51, SEQ ID NO:52, SEQ ID NO:53, SEQ IDNO:54, SEQ ID NO:55, SEQ ID NO:107, SEQ ID NO:108, SEQ ID NO:109, SEQ IDNO:110, SEQ ID NO:111, SEQ ID NO:112, SEQ ID NO:113, SEQ ID NO:114 orSEQ ID NO:115. More preferably the controlled-release PTH molecule ormoiety has the sequence of SEQ ID NO:50, SEQ ID NO:51, SEQ ID NO:52, SEQID NO:110, SEQ ID NO:111 or SEQ ID NO:112.

In one embodiment the PTH molecule or moiety has the sequence of SEQ IDNO:50.

In another embodiment the PTH molecule or moiety has the sequence of SEQID NO:52.

In another embodiment the PTH molecule or moiety has the sequence of SEQID NO: 110.

In another embodiment the PTH molecule or moiety has the sequence of SEQID NO:111.

In another embodiment the PTH molecule or moiety has the sequence of SEQID NO: 112.

Most preferably the PTH molecule or moiety has the sequence of SEQ IDNO:51.

In one embodiment the controlled-release PTH compound iswater-insoluble.

Preferably, a water-insoluble controlled-release PTH compound isselected from the group consisting of crystals, nanoparticles,microparticles, nanospheres and microspheres.

In one embodiment the water-insoluble controlled-release PTH compound isa crystal comprising at least one PTH molecule or moiety.

In another embodiment the water-insoluble controlled-release PTHcompound is a nanoparticle comprising at least one PTH molecule ormoiety.

In another embodiment the water-insoluble controlled-release PTHcompound is a microparticle comprising at least one PTH molecule ormoiety.

In another embodiment the water-insoluble controlled-release PTHcompound is a nanosphere comprising at least one PTH molecule or moiety.

In another embodiment the water-insoluble controlled-release PTHcompound is a microsphere comprising at least one PTH molecule ormoiety.

In one embodiment the water-insoluble controlled-release PTH compound isa vesicle comprising at least one PTH molecule or moiety. Preferably,such vesicle comprising at least one PTH molecule or moiety is amicelle, liposome or polymersome.

In one embodiment the water-insoluble controlled-release PTH compound isa micelle comprising at least one PTH molecule or moiety.

In another embodiment the water-insoluble controlled-release PTHcompound is a liposome comprising at least one PTH molecule or moiety.Preferably, such liposome is selected from the group consisting ofaquasomes; non-ionic surfactant vesicles, such as niosomes andproniosomes; cationic liposomes, such as LeciPlex; transfersomes;ethosomes; ufasomes; sphingosomes; and pharmacosomes.

In another embodiment the water-insoluble controlled-release PTHcompound is a polymersome comprising at least one PTH molecule ormoiety.

In another embodiment the water-insoluble controlled-release PTHcompound comprises at least one PTH molecule or moiety non-covalentlyembedded in a water-insoluble polymer. Preferably, such water-insolublepolymer comprises a polymer selected from the group consisting of2-methacryloyl-oxyethyl phosphoyl cholins, poly(acrylic acids),poly(acrylates), poly(acrylamides), poly(alkyloxy) polymers,poly(amides), poly(amidoamines), poly(amino acids), poly(anhydrides),poly(aspartamides), poly(butyric acids), poly(glycolic acids),polybutylene terephthalates, poly(caprolactones), poly(carbonates),poly(cyanoacrylates), poly(dimethylacrylamides), poly(esters),poly(ethylenes), poly(ethyleneglycols), poly(ethylene oxides),poly(ethyl phosphates), poly(ethyloxazolines), poly(glycolic acids),poly(hydroxyethyl acrylates), poly(hydroxyethyl-oxazolines),poly(hydroxymethacrylates), poly(hydroxypropylmethacrylamides),poly(hydroxypropyl methacrylates), poly(hydroxypropyloxazolines),poly(iminocarbonates), poly(lactic acids), poly(lactic-co-glycolicacids), poly(methacrylamides), poly(methacrylates),poly(methyloxazolines), poly(organophosphazenes), poly(ortho esters),poly(oxazolines), poly(propylene glycols), poly(siloxanes),poly(urethanes), poly(vinyl alcohols), poly(vinyl amines),poly(vinylmethylethers), poly(vinylpyrrolidones), silicones, celluloses,carbomethyl celluloses, hydroxypropyl methylcelluloses, chitins,chitosans, dextrans, dextrins, gelatins, hyaluronic acids andderivatives, functionalized hyaluronic acids, mannans, pectins,rhamnogalacturonans, starches, hydroxyalkyl starches, hydroxyethylstarches and other carbohydrate-based polymers, xylans, and copolymersthereof.

In a preferred embodiment the water-insoluble controlled-release PTHcompound comprises at least one PTH molecule or moiety non-covalentlyembedded in poly(lactic-co-glycolic acid) (PLGA).

In another embodiment the water-insoluble controlled-release PTHcompound comprises at least one PTH moiety covalently and reversiblyconjugated to a water-insoluble polymer. Preferably such water-insolublepolymer comprises a polymer selected from the group consisting of2-methacryloyl-oxyethyl phosphoyl cholins, poly(acrylic acids),poly(acrylates), poly(acrylamides), poly(alkyloxy) polymers,poly(amides), poly(amidoamines), poly(amino acids), poly(anhydrides),poly(aspartamides), poly(butyric acids), poly(glycolic acids),polybutylene terephthalates, poly(caprolactones), poly(carbonates),poly(cyanoacrylates), poly(dimethylacrylamides), poly(esters),poly(ethylenes), poly(ethyleneglycols), poly(ethylene oxides),poly(ethyl phosphates), poly(ethyloxazolines), poly(glycolic acids),poly(hydroxyethyl acrylates), poly(hydroxyethyl-oxazolines),poly(hydroxymethacrylates), poly(hydroxypropylmethacrylamides),poly(hydroxypropyl methacrylates), poly(hydroxypropyloxazolines),poly(iminocarbonates), poly(lactic acids), poly(lactic-co-glycolicacids), poly(methacrylamides), poly(methacrylates),poly(methyloxazolines), poly(organophosphazenes), poly(ortho esters),poly(oxazolines), poly(propylene glycols), poly(siloxanes),poly(urethanes), poly(vinyl alcohols), poly(vinyl amines),poly(vinylmethylethers), poly(vinylpyrrolidones), silicones, celluloses,carbomethyl celluloses, hydroxypropyl methylcelluloses, chitins,chitosans, dextrans, dextrins, gelatins, hyaluronic acids andderivatives, functionalized hyaluronic acids, mannans, pectins,rhamnogalacturonans, starches, hydroxyalkyl starches, hydroxyethylstarches and other carbohydrate-based polymers, xylans, and copolymersthereof.

In one embodiment such water-insoluble controlled-release PTH compoundis a compound comprising a conjugate D-L, wherein

-   -   -D is a PTH moiety; and    -   -L comprises a reversible prodrug linker moiety -L¹-, which        moiety -L¹- is connected to the PTH moiety -D through a        functional group of PTH;    -   wherein -L¹- is substituted with -L²-Z′ and is optionally        further substituted; wherein    -   L²- is a single chemical bond or a spacer moiety; and    -   —Z′ is a water-insoluble carrier moiety.

It is understood that a multitude of moieties -L²-L¹-D is connected to awater-insoluble carrier —Z′ and that such controlled-release PTHcompounds are PTH prodrugs, more specifically carrier-linked PTHprodrugs.

Preferred embodiments for -D, -L¹-, -L²- and —Z′ are as described below.

In a preferred embodiment the controlled-release PTH compound iswater-soluble.

In a preferred embodiment such water-soluble controlled-release PTHcompound is a compound of formula (Ia) or (Ib) or a pharmaceuticallyacceptable salt thereof

ZL²-L¹D)_(x)  (Ia)

DL¹-L²-Z)_(y)  (Ib),

-   -   wherein    -   -D is a PTH moiety;    -   -L¹- is a reversible prodrug linker moiety connected to the PTH        moiety -D through a functional group of PTH;    -   -L²- is a single chemical bond or a spacer moiety;    -   —Z is a water-soluble carrier moiety;    -   x is an integer selected from the group consisting of 1, 2, 3,        4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 or 16; and    -   y is an integer selected from the group consisting of 1, 2, 3, 4        and 5.

It is understood that the compounds of formula (Ia) and (Ib) are PTHprodrugs, more specifically water-soluble PTH prodrugs.

Preferably, -D has the sequence of SEQ ID NO:47, SEQ ID NO:48, SEQ IDNO:49, SEQ ID NO:50, SEQ ID NO:51, SEQ ID NO:52, SEQ ID NO:53, SEQ IDNO:54, SEQ ID NO:55, SEQ ID NO:107, SEQ ID NO:108, SEQ ID NO:109, SEQ IDNO:110, SEQ ID NO:111, SEQ ID NO:112, SEQ ID NO:113, SEQ ID NO:114 orSEQ ID NO:115. More preferably -D has the sequence of SEQ ID NO:50, SEQID NO:51, SEQ ID NO:52, SEQ ID NO:110, SEQ ID NO:111 or SEQ ID NO:112.

In one embodiment -D has the sequence of SEQ ID NO:50.

In another embodiment -D has the sequence of SEQ ID NO:52.

In another embodiment -D has the sequence of SEQ ID NO:110.

In another embodiment -D has the sequence of SEQ ID NO:111.

In another embodiment -D has the sequence of SEQ ID NO: 112.

Most preferably -D has the sequence of SEQ ID NO:51.

The moiety -L¹- is either conjugated to a functional group of the sidechain of an amino acid residue of -D, to the N-terminal amine functionalgroup or to the C-terminal carboxyl functional group of -D or to anitrogen atom in the backbone polypeptide chain of -D. Attachment toeither the N-terminus or C-terminus can either be directly through thecorresponding amine or carboxyl functional group, respectively, orindirectly wherein a spacer moiety is first conjugated to the amine orcarboxyl functional group to which spacer moiety -L¹- is conjugated.

Preferably, the amino acid residue of PTH to which -L¹- is conjugatedcomprises a functional group selected from the group consistingcarboxylic acid, primary and secondary amine, maleimide, thiol, sulfonicacid, carbonate, carbamate, hydroxyl, aldehyde, ketone, hydrazine,isocyanate, isothiocyanate, phosphoric acid, phosphonic acid,haloacetyl, alkyl halide, acryloyl, aryl fluoride, hydroxylamine,sulfate, disulfide, vinyl sulfone, vinyl ketone, diazoalkane, oxirane,guanidine and aziridine. Even more preferably the amino acid residue ofPTH to which -L¹- is conjugated comprises a functional group selectedfrom the group consisting hydroxyl, primary and secondary amine andguanidine. Even more preferably the amino acid residue of PTH to which-L¹- is conjugated comprises a primary or secondary amine functionalgroup. Most preferably the amino acid residue of PTH to which -L¹- isconjugated comprises a primary amine functional group.

If the moiety -L¹- is conjugated to a functional group of the side chainof an amino acid residue of PTH said amino acid residue is selected fromthe group consisting of proteinogenic amino acid residues andnon-proteinogenic amino acid residues.

In one embodiment -L¹- is conjugated to a functional group of the sidechain of a non-proteinogenic amino acid residue of PTH. It is understoodthat such non-proteinogenic amino acid is not found in the sequence ofnative PTH or fragments thereof and that it may only be present invariants, analogs, orthologs, homologs and derivatives of PTH.

In another embodiment -L¹- is conjugated to a functional group of theside chain of a proteinogenic amino acid residue of PTH. Preferably saidamino acid is selected from the group consisting of histidine, lysine,tryptophan, serine, threonine, tyrosine, aspartic acid, glutamic acidand arginine. Even more preferably said amino acid is selected from thegroup consisting of lysine, aspartic acid, arginine and serine. Evenmore preferably said amino acid is selected from the group consisting oflysine, arginine and serine.

In one embodiment -L¹- is conjugated to a functional group of the sidechain of a histidine of PTH.

In another embodiment -L¹- is conjugated to a functional group of theside chain of a lysine of PTH.

In another embodiment -L¹- is conjugated to a functional group of theside chain of a tryptophan of PTH.

In another embodiment -L¹- is conjugated to a functional group of theside chain of a serine of PTH.

In another embodiment -L¹- is conjugated to a functional group of theside chain of a threonine of PTH.

In another embodiment -L¹- is conjugated to a functional group of theside chain of a tyrosine of PTH.

In another embodiment -L¹- is conjugated to a functional group of theside chain of an aspartic acid of PTH.

In another embodiment -L¹- is conjugated to a functional group of theside chain of a glutamic acid of PTH.

In another embodiment -L¹- is conjugated to a functional group of theside chain of an arginine of PTH.

It is understood that not every PTH moiety may comprise all of theseamino acid residues.

In a preferred embodiment -L¹- is conjugated to the N-terminal aminefunctional group of PTH, either directly through the corresponding aminefunctional group or indirectly wherein a spacer moiety is firstconjugated to the amine functional group to which spacer moiety -L¹- isconjugated. Even more preferably, -L¹- is directly conjugated to theN-terminal amine functional group of PTH.

In an equally preferred embodiment -L¹- is conjugated to the C-terminalfunctional group of PTH, either directly through the correspondingcarboxyl functional group or indirectly wherein a spacer moiety is firstconjugated to the carboxyl functional group to which spacer moiety -L¹-is conjugated.

Most preferably L¹- is directly conjugated to the N-terminal aminefunctional group of PTH.

The moiety -L¹- can be connected to -D through any type of linkage,provided that it is reversible. Preferably, -L¹- is connected to -Dthrough a linkage selected from the group consisting of amide, ester,carbamate, acetal, aminal, imine, oxime, hydrazone, disulfide andacylguanidine. Even more preferably -L¹- is connected to -D through alinkage selected from the group consisting of amide, ester, carbamateand acylguanidin. It is understood that some of these linkages are notreversible per se, but that in the present invention neighboring groupscomprised in -L¹- render these linkage reversible.

In one embodiment -L¹- is connected to -D through an ester linkage.

In another embodiment -L¹- is connected to -D through a carbamatelinkage.

In another embodiment -L¹- is connected to -D through an acylguanidine.

In a preferred embodiment -L¹- is connected to -D through an amidelinkage.

The moiety -L¹- is a reversible prodrug linker from which the drug, i.e.PTH, is released in its free form, i.e. it is a traceless prodruglinker. Suitable prodrug linkers are known in the art, such as forexample the reversible prodrug linker moieties disclosed in WO2005/099768 A2, WO 2006/136586 A2, WO 2011/089216 A1 and WO 2013/024053A1, which are incorporated by reference herewith.

In another embodiment -L¹- is a reversible prodrug linker as describedin WO 2011/012722 A1, WO 2011/089214 A1, WO 2011/089215 A1, WO2013/024052 A1 and WO 2013/160340 A1 which are incorporated by referenceherewith.

A particularly preferred moiety -L¹- is disclosed in WO 2009/095479 A2.Accordingly, in a preferred embodiment the moiety -L¹- is of formula(II):

-   -   wherein the dashed line indicates the attachment to a nitrogen,        hydroxyl or thiol of -D which is a PTH moiety;    -   —X— is selected from the group consisting of —C(R⁴R^(4a))—;        —N(R⁴)—; —O—; —C(R⁴R^(4a))—C(R⁵R^(5a))—;        —C(R⁵R^(5a))—C(R⁴R^(4a))—; —C(R⁴R^(4a))—N(R⁶)—;        —N(R⁶)—C(R⁴R^(4a))—; —C(R⁴R^(4a))—O—; —O—C(R⁴R^(4a))—; AND        —C(R⁷R^(7a))—;    -   X¹ is selected from the group consisting of C; and S(O);    -   —X²- is selected from the group consisting of —C(R⁸R^(8a))—; and        —C(R⁸R^(8a))—C(R⁹R^(9a))—;    -   ═X³ is selected from the group consisting of ═O; ═S; and ═N—CN;    -   —R¹, —R^(1a), —R², —R^(2a), —R⁴, —R^(4a), —R⁵, —R^(5a), —R⁶,        —R⁸, —R^(8a), —R⁹, —R^(9a) are independently selected from the        group consisting of —H; and C₁₋₆ alkyl;    -   —R³, —R^(3a) are independently selected from the group        consisting of —H; and C₁₋₆ alkyl, provided that in case one of        —R³, —R^(3a) or both are other than —H they are connected to N        to which they are attached through an SP³-hybridized carbon        atom;    -   —R⁷ is selected from the group consisting of —N(R¹⁰R^(10a)); and        —NR¹⁰—(C═O)—R¹¹;    -   —R^(7a), —R¹⁰, —R^(10a), —R¹¹ are independently of each other        selected from the group consisting of —H; and C₁₋₆ alkyl;    -   optionally, one or more of the pairs —R^(1a)/—R^(4a),        —R^(1a)/—R^(5a), —R^(1a)/—R^(7a), —R^(4a)/—R^(5a),        —R^(8a)/—R^(9a) form a chemical bond;    -   optionally, one or more of the pairs —R¹/—R^(1a), —R²/—R^(2a),        —R⁴/—R^(4a), —R⁵/—R^(5a), —R⁸/—R^(8a), —R⁹/—R^(9a) are joined        together with the atom to which they are attached to form a        C₃₋₁₀ cycloalkyl; or 3- to 10-membered heterocyclyl;    -   optionally, one or more of the pairs —R¹/—R⁴, —R¹/—R⁵, —R¹/—R⁶,        —R¹/—R^(7a), —R⁴/—R⁵, —R⁴/—R⁶, —R⁸/—R⁹, —R²/—R³ are joined        together with the atoms to which they are attached to form a        ring A;    -   optionally, R³/R^(3a) are joined together with the nitrogen atom        to which they are attached to form a 3- to 10-membered        heterocycle;    -   A is selected from the group consisting of phenyl; naphthyl;        indenyl; indanyl; tetralinyl; C₃₋₁₀ cycloalkyl; 3- to        10-membered heterocyclyl; and 8- to 11-membered heterobicyclyl;        and    -   wherein -L¹- is substituted with -L²-Z or -L²-Z′ and wherein        -L¹- is optionally further substituted, provided that the        hydrogen marked with the asterisk in formula (II) is not        replaced by -L²-Z or -L²-Z′ or a substituent;        -   wherein        -   -L²- is a single chemical bond or a spacer;        -   —Z is a water-soluble carrier; and        -   —Z′ is a water-insoluble carrier.

Preferably -L¹- of formula (II) is substituted with one moiety -L²-Z or-L²-Z′.

In one embodiment -L¹- of formula (II) is not further substituted.

It is understood that if —R³/—R^(3a) of formula (II) are joined togetherwith the nitrogen atom to which they are attached to form a 3- to10-membered heterocycle, only such 3- to 10-membered heterocycles may beformed in which the atoms directly attached to the nitrogen areSP³-hybridized carbon atoms. In other words, such 3- to 10-memberedheterocycle formed by —R³/—R^(3a) together with the nitrogen atom towhich they are attached has the following structure:

-   -   wherein    -   the dashed line indicates attachment to the rest of -L¹-;    -   the ring comprises 3 to 10 atoms comprising at least one        nitrogen; and    -   R# and R## represent an SP³-hydridized carbon atom.

It is also understood that the 3- to 10-membered heterocycle may befurther substituted.

Exemplary embodiments of suitable 3- to 10-membered heterocycles formedby —R³/—R^(3a) of formula (II) together with the nitrogen atom to whichthey are attached are the following:

-   -   wherein    -   dashed lines indicate attachment to the rest of the molecule;        and    -   —R is selected from the group consisting of —H and C₁₋₆ alkyl.    -   L¹- of formula (II) may optionally be further substituted. In        general, any substituent may be used as far as the cleavage        principle is not affected, i.e. the hydrogen marked with the        asterisk in formula (II) is not replaced and the nitrogen of the        moiety

of formula (II) remains part of a primary, secondary or tertiary amine,i.e. —R³ and —R^(3a) are independently of each other —H or are connectedto —N< through an SP³-hybridized carbon atom.

In one embodiment —R¹ or —R^(1a) of formula (II) is substituted with-L²-Z or -L²-Z′. In another embodiment —R² or —R^(2a) of formula (II) issubstituted with -L²-Z or -L²-Z′. In another embodiment —R³ or —R^(3a)of formula (II) is substituted with -L²-Z or -L²-Z′. In anotherembodiment —R⁴ of formula (II) is substituted with -L²-Z or -L²-Z′. Inanother embodiment —R⁵ or —R^(5a) of formula (II) is substituted with-L²-Z or -L²-Z′. In another embodiment —R⁶ of formula (II) issubstituted with -L²-Z or -L²-Z′. In another embodiment —R⁷ or —R^(7a)of formula (II) is substituted with -L²-Z or -L²-Z′. In anotherembodiment —R⁸ or —R^(8a) of formula (II) is substituted with -L²-Z or-L²-Z′. In another embodiment —R⁹ or —R^(9a) of formula (II) issubstituted with -L²-Z or -L²-Z′. In another embodiment —R¹⁰ issubstituted with -L²-Z or -L²-Z′. In another embodiment —R¹¹ issubstituted with -L²-Z or -L²-Z′.

Preferably, —X— of formula (II) is selected from the group consisting of—C(R⁴R^(4a))—, —N(R⁴)— and —C(R⁷R^(7a))—.

In one embodiment —X— of formula (II) is —C(R⁴R^(4a))—.

In one preferred embodiment —X— of formula (II) is —C(R⁷R^(7a))—.

Preferably, —R⁷ of formula (II) is —NR¹⁰—(C═O)—R¹¹.

Preferably, —R^(7a) of formula (II) is selected from —H, methyl andethyl. Most preferably —R^(7a) of formula (II) is —H.

Preferably, —R¹⁰ is selected from —H, methyl and ethyl. Most preferably—R¹⁰ is methyl.

Preferably, —R¹¹ is selected from —H, methyl and ethyl. Most preferably—R¹¹ is —H.

Preferably, —R¹¹ is substituted with -L²-Z or -L²-Z′.

In another preferred embodiment —X— of formula (II) is —N(R⁴)—.

Preferably, —R⁴ is selected from the group consisting of —H, methyl andethyl. Preferably, —R⁴ is —H.

Preferably, X¹ of formula (II) is C.

Preferably, ═X³ of formula (II) is ═O.

Preferably, —X²— of formula (II) is —C(R⁸R^(8a))—.

Preferably —R⁸ and —R^(8a) of formula (II) are independently selectedfrom the group consisting of —H, methyl and ethyl. More preferably atleast one of —R⁸ and —R^(8a) of formula (II) is —H. Even more preferablyboth —R⁸ and —R^(8a) of formula (II) are —H.

Preferably, —R¹ and —R^(1a) of formula (II) are independently selectedfrom the group consisting of —H, methyl and ethyl.

In one preferred embodiment at least one of —R¹ and —R^(1a) of formula(II) is —H, more preferably both —R¹ and —R^(1a) of formula (II) are —H.

In another preferred embodiment at least one of —R¹ and —R^(1a) offormula (II) is methyl, more preferably both —R¹ and —R^(1a) of formula(II) are methyl.

Preferably, —R² and —R^(2a) of formula (II) are independently selectedfrom the group consisting of —H, methyl and ethyl. More preferably, atleast one of —R² and —R^(2a) of formula (II) is —H. Even more preferablyboth —R² and —R^(2a) of formula (II) are H.

Preferably, —R³ and —R^(3a) of formula (II) are independently selectedfrom the group consisting of —H, methyl, ethyl, propyl and butyl.

In one preferred embodiment at least one of —R³ and —R^(3a) of formula(II) is methyl, more preferably —R³ of formula (II) is methyl and—R^(3a) of formula (II) is —H.

In another preferred embodiment —R³ and —R^(3a) of formula (II) are both—H.

Preferably, -D is connected to -L¹- through a nitrogen by forming anamide bond.

In one preferred embodiment the moiety -L¹- is of formula (IIa-i):

-   -   wherein    -   the dashed line indicates the attachment to a nitrogen of -D        which is a PTH moiety by forming an amide bond;    -   —R¹, —R^(1a), —R², —R^(2a), —R³, —R^(3a), —R⁷, —R^(7a) and —X²—        are used as defined in formula (II); and    -   wherein -L¹- is substituted with -L²-Z or -L²-Z′ and wherein        -L¹- is optionally further substituted, provided that the        hydrogen marked with the asterisk in formula (IIa-i) is not        replaced by -L²-Z or -L²-Z′ or a substituent.

Preferably -L¹- of formula (IIa-i) is substituted with one moiety -L²-Zor -L²-Z′.

Preferably the moiety -L¹- of formula (IIa-i) is not furthersubstituted.

Preferably, —R¹ and —R^(1a) of formula (IIa-i) are independentlyselected from the group consisting of —H, methyl and ethyl. Morepreferably, at least one of —R¹ and —R^(1a) of formula (IIa-i) is —H.Even more preferably both —R¹ and —R^(1a) of formula (IIa-i) are —H.

Preferably, —R⁷ of formula (IIa-i) is —NR¹⁰—(C═O)—R¹¹.

Preferably, —R^(7a) of formula (II-i) is selected from —H, methyl andethyl. Most preferably —R^(7a) of formula (II-i) is —H.

Preferably, —R¹⁰ of formula (IIa-i) is selected from —H, methyl andethyl. Most preferably —R¹⁰ of formula (IIa-i) is methyl.

Preferably, —R¹¹ of formula (IIa-i) is selected from —H, methyl andethyl. Most preferably —R¹¹ of formula (IIa-i) is —H.

Preferably, —R¹ of formula (IIa-i) is substituted with -L²-Z or -L²-Z′.

Preferably, —X²— of formula (IIa-i) is —C(R⁸R^(8a))—.

Preferably —R⁸ and —R^(8a) of formula (IIa-i) are independently selectedfrom the group consisting of —H, methyl and ethyl. More preferably atleast one of —R⁸ and —R^(8a) of formula (IIa-i) is —H. Even morepreferably both —R⁸ and —R^(8a) of formula (IIa-i) are —H.

Preferably, —R² and —R^(2a) of formula (IIa-i) are independentlyselected from the group consisting of —H, methyl and ethyl. Morepreferably, at least one of —R² and —R^(2a) of formula (IIa-i) is —H.Even more preferably both —R² and —R^(2a) of formula (IIa-i) are H.

Preferably, —R³ and —R^(3a) of formula (IIa-i) are independentlyselected from the group consisting of —H, methyl, ethyl, propyl andbutyl. Even more preferably at least one of —R³ and —R^(3a) of formula(IIa-i) is methyl.

Preferably, —R³ of formula (IIa-i) is —H and —R^(3a) of formula (IIa-i)is methyl.

More preferably the moiety -L¹- is of formula (IIa-ii):

-   -   wherein the dashed line indicates the attachment to a nitrogen        of -D which is a PTH moiety by forming an amide bond;    -   —R², —R^(2a), —R¹⁰, —R¹¹ and —X²— are used as defined in formula        (II); and    -   wherein -L¹- is substituted with -L²-Z or -L²-Z′ and wherein        -L¹- is optionally further substituted, provided that the        hydrogen marked with the asterisk in formula (IIa-ii) is not        replaced by -L²-Z or -L²-Z′ or a substituent.

Preferably -L¹- of formula (IIa-ii) is substituted with one moiety -L²-Zor -L²-Z′.

Preferably the moiety -L¹- of formula (IIa-ii) is not furthersubstituted.

Preferably, —X²— of formula (IIa-ii) is —C(R⁸R^(8a))—.

Preferably —R⁸ and —R^(8a) of formula (IIa-ii) are independentlyselected from the group consisting of —H, methyl and ethyl. Morepreferably at least one of —R⁸ and —R^(8a) of formula (IIa-ii) is —H.Even more preferably both —R⁸ and —R^(8a) of formula (IIa-ii) are —H.

Preferably, —R³ and —R^(3a) of formula (IIa-ii) are independentlyselected from the group consisting of —H, methyl, ethyl, propyl andbutyl. Even more preferably at least one of —R³ and —R^(3a) of formula(IIa-ii) is methyl.

Preferably, —R³ of formula (IIa-ii) is —H and —R^(3a) of formula(IIa-ii) is methyl.

Preferably, —R¹⁰ of formula (IIa-ii) is selected from —H, methyl andethyl. Most preferably —R¹⁰ of formula (IIa-ii) is methyl.

Preferably, —R¹¹ of formula (IIa-ii) is selected from —H, methyl andethyl. Most preferably —R¹¹ of formula (IIa-ii) is —H.

Preferably, —R¹¹ of formula (IIa-ii) is substituted with -L²-Z or-L²-Z′.

In an even more preferred embodiment the moiety -L¹- is of formula(IIa-ii′):

-   -   wherein    -   wherein the dashed line indicates the attachment to a nitrogen        of D which is a PTH moiety by forming an amide bond;    -   the dashed line marked with the asterisk indicates attachment to        -L²-;    -   —R³, —R^(3a), —R¹⁰ and —X²- are used as defined in formula (II);        and    -   wherein -L¹- is optionally further substituted, provided that        the hydrogen marked with the asterisk in formula (IIa-ii′) is        not replaced by a substituent.

Preferably the moiety -L¹- of formula (IIa-ii′) is not furthersubstituted.

Preferably, —X²— of formula (IIa-ii′) is —C(R⁸R^(8a))—.

Preferably —R⁸ and —R^(8a) of formula (IIa-ii′) are independentlyselected from the group consisting of —H, methyl and ethyl. Morepreferably at least one of —R⁸ and —R^(8a) of formula (IIa-ii′) is —H.Even more preferably both —R⁸ and —R^(8a) of formula (IIa-ii′) are —H.

Preferably, —R³ and —R^(3a) of formula (IIa-ii′) are independentlyselected from the group consisting of —H, methyl, ethyl, propyl andbutyl. Even more preferably at least one of —R³ and —R^(3a) of formula(IIa-ii′) is methyl.

Preferably, —R³ of formula (IIa-ii′) is —H and —R^(3a) of formula(IIa-ii′) is methyl.

Preferably, —R¹⁰ of formula (IIa-ii′) is selected from —H, methyl andethyl. Most preferably —R¹⁰ of formula (IIa-ii′) is methyl.

Even more preferably the moiety -L¹- is of formula (IIa-iii):

-   -   wherein the dashed line indicates the attachment to a nitrogen        of -D which is a PTH moiety by forming an amide bond; and    -   wherein -L¹- is substituted with -L²-Z or -L²-Z′ and wherein        -L¹- is optionally further substituted, provided that the        hydrogen marked with the asterisk in formula (IIa-iii) is not        replaced by -L²-Z or -L²-Z′ or a substituent.

Preferably -L¹- of formula (IIa-iii) is substituted with one moiety-L²-Z or -L²-Z′.

Preferably the moiety -L¹- of formula (IIa-iii) is not furthersubstituted.

Most preferably the moiety -L¹- is of formula (IIa-iii′):

-   -   wherein    -   wherein the dashed line indicates the attachment to a nitrogen        of D which is a PTH moiety by forming an amide bond;    -   the dashed line marked with the asterisk indicates attachment to        -L²-;    -   —R², —R^(2a), —R³, —R^(3a) and —X²— are used as defined in        formula (II); and    -   wherein -L¹- is optionally further substituted, provided that        the hydrogen marked with the asterisk in formula (IIa-iii′) is        not replaced by a substituent.

Preferably the moiety -L¹- of formula (IIa-iii′) is not furthersubstituted.

In another preferred embodiment the moiety -L¹- is of formula (IIb-i)

-   -   wherein    -   the dashed line indicates the attachment to a nitrogen of -D        which is a PTH moiety by forming an amide bond;    -   —R¹, —R^(1a), —R², —R^(2a), —R³, —R^(3a), —R⁴ and —X²— are used        as defined in formula (II); and wherein -L¹- is substituted with        -L²-Z or -L²-Z′ and wherein -L¹- is optionally further        substituted, provided that the hydrogen marked with the asterisk        in formula (IIb-i) is not replaced by -L²-Z or -L²-Z′ or a        substituent.

Preferably -L¹- of formula (IIb-i) is substituted with one moiety -L²-Zor -L²-Z′.

Preferably the moiety -L¹- of formula (IIb-i) is not furthersubstituted.

Preferably, —R¹ and —R^(1a) of formula (IIb-i) are independentlyselected from the group consisting of —H, methyl and ethyl. Morepreferably, at least one of —R¹ and —R^(1a) of formula (IIb-i) ismethyl. Even more preferably both —R¹ and —R^(1a) of formula (IIb-i) aremethyl.

Preferably, —R⁴ of formula (IIb-i) is selected from the group consistingof —H, methyl and ethyl. More preferably, —R⁴ of formula (IIb-i) is —H.

Preferably, —X²— of formula (IIb-i) is —C(R⁸R^(8a))—.

Preferably —R⁸ and —R^(8a) of formula (IIb-i) are independently selectedfrom the group consisting of —H, methyl and ethyl. More preferably atleast one of —R⁸ and —R^(8a) of formula (IIb-i) is —H. Even morepreferably both —R⁸ and —R^(8a) of formula (IIb-i) are —H.

Preferably, —R² and —R^(2a) of formula (IIb-i) are independentlyselected from the group consisting of —H, methyl and ethyl. Morepreferably, at least one of —R² and —R^(2a) of formula (IIb-i) is —H.Even more preferably both —R² and —R^(2a) of formula (IIb-i) are H.

Preferably, —R³ and —R^(3a) of formula (IIb-i) are independentlyselected from the group consisting of —H, methyl, ethyl, propyl andbutyl. Even more preferably at least one of —R³ and —R^(3a) of formula(IIb-i) is —H. Even more preferably both —R³ and —R^(3a) of formula(IIb-i) are —H.

More preferably the moiety -L¹- is of formula (IIb-ii):

-   -   wherein the dashed line indicates the attachment to a nitrogen        of -D which is a PTH moiety by forming an amide bond;    -   —R², —R^(2a), —R³, —R^(3a) and —X²— are used as defined in        formula (II); and wherein -L¹- is substituted with -L²-Z or        -L²-Z′ and wherein -L¹- is optionally further substituted,        provided that the hydrogen marked with the asterisk in formula        (IIb-ii) is not replaced by -L²-Z or -L²-Z′ or a substituent.

Preferably -L¹- of formula (IIb-ii) is substituted with one moiety -L²-Zor -L²-Z′.

Preferably the moiety -L¹- of formula (IIb-ii) is not furthersubstituted.

Preferably, —X²— of formula (IIb-ii) is —C(R⁸R^(8a))—.

Preferably —R⁸ and —R^(8a) of formula (IIb-ii) are independentlyselected from the group consisting of —H, methyl and ethyl. Morepreferably at least one of —R⁸ and —R^(8a) of formula (IIb-ii) is —H.Even more preferably both —R⁸ and —R^(8a) of formula (IIb-ii) are —H.

Preferably, —R² and —R^(2a) of formula (IIb-ii) are independentlyselected from the group consisting of —H, methyl and ethyl. Morepreferably, at least one of —R² and —R^(2a) of formula (IIb-ii) is —H.Even more preferably both —R² and —R^(2a) of formula (IIb-ii) are H.

Preferably, —R³ and —R^(3a) of formula (IIb-ii) are independentlyselected from the group consisting of —H, methyl, ethyl, propyl andbutyl. Even more preferably at least one of —R³ and —R^(3a) of formula(IIb-ii) is —H. Even more preferably both —R³ and —R^(3a) of formula(IIb-ii) are —H.

Even more preferably the moiety -L¹- is of formula (IIb-ii′):

-   -   wherein    -   the dashed line indicates the attachment to a nitrogen of -D        which is a PTH moiety by forming an amide bond;    -   —R², —R^(2a), —R³, —R^(3a) and —X²— are used as defined in        formula (II); and    -   wherein -L¹- is substituted with -L²-Z or -L²-Z′ and wherein        -L¹- is optionally further substituted, provided that the        hydrogen marked with the asterisk in formula (IIb-ii′) is not        replaced by -L²-Z or -L²-Z′ or a substituent.

Preferably the moiety -L¹- of formula (IIb-ii′) is not furthersubstituted.

Preferably, —X²— of formula (IIb-ii′) is —C(R⁸R^(8a))—.

Preferably —R⁸ and —R^(8a) of formula (IIb-ii′) are independentlyselected from the group consisting of —H, methyl and ethyl. Morepreferably at least one of —R⁸ and —R^(8a) of formula (IIb-ii′) is —H.Even more preferably both —R⁸ and —R^(8a) of formula (IIb-ii′) are —H.

Preferably, —R² and —R^(2a) of formula (IIb-ii′) are independentlyselected from the group consisting of —H, methyl and ethyl. Morepreferably, at least one of —R² and —R^(2a) of formula (IIb-ii′) is —H.Even more preferably both —R² and —R^(2a) of formula (IIb-ii′) are H.

Preferably, —R³ and —R^(3a) of formula (IIb-ii′) are independentlyselected from the group consisting of —H, methyl, ethyl, propyl andbutyl. Even more preferably at least one of —R³ and —R^(3a) of formula(IIb-ii′) is —H. Even more preferably both —R³ and —R^(3a) of formula(IIb-ii′) are —H.

Even more preferably the moiety -L¹- is of formula (IIb-iii):

-   -   wherein    -   the dashed line indicates the attachment to a nitrogen of -D        which is a PTH moiety by forming an amide bond; and    -   wherein -L¹- is substituted with -L²-Z or -L²-Z′ and wherein        -L¹- is optionally further substituted, provided that the        hydrogen marked with the asterisk in formula (IIb-iii) is not        replaced by -L²-Z or -L²-Z′ or a substituent.

Preferably -L¹- of formula (IIb-iii) is substituted with one moiety-L²-Z or -L²-Z′.

Preferably the moiety -L¹- of formula (IIb-iii) is not furthersubstituted.

Most preferably the moiety -L¹- is of formula (IIb-iii′):

-   -   wherein    -   the dashed line indicates the attachment to a nitrogen of -D        which is a PTH moiety by forming an amide bond;    -   —R², —R^(2a), —R³, —R^(3a) and —X²— are used as defined in        formula (II); and    -   wherein -L¹- is substituted with -L²-Z or -L²-Z′ and wherein        -L¹- is optionally further substituted, provided that the        hydrogen marked with the asterisk in formula (IIb-iii′) is not        replaced by -L²-Z or -L²-Z′ or a substituent.

Preferably the moiety -L¹- of formula (IIb-iii′) is not furthersubstituted.

Another preferred moiety -L¹- is disclosed in WO2016/020373A1.Accordingly, in another preferred embodiment the moiety -L¹- is offormula (III):

-   -   wherein    -   the dashed line indicates attachment to a primary or secondary        amine or hydroxyl of -D which is a PTH moiety by forming an        amide or ester linkage, respectively;    -   —R¹, —R^(1a), —R², —R^(2a), —R³ and —R^(3a) are independently of        each other selected from the group consisting of —H,        —C(R⁸R^(8a)R^(8b)), —C(═O)R⁸, —C—N, —C(═NR⁸)R^(8a),        —CR⁸(═CR^(8a)R^(8b)), —C≡CR⁸ and -T;    -   —R⁴, —R⁵ and —R^(5a) are independently of each other selected        from the group consisting of —H, —C(R⁹R^(9a)R^(9b)) and -T;    -   a1 and a2 are independently of each other 0 or 1;    -   each —R⁶, —R^(6a), —R⁷, —R^(7a), —R⁸, —R^(8a), —R^(8b), —R⁹,        —R^(9a), —R^(9b) are independently of each other selected from        the group consisting of —H, halogen, —CN, —COOR¹⁰, —OR¹⁰,        —C(O)R¹⁰, —C(O)N(R¹⁰R^(10a)), —S(O)₂N(R¹⁰R^(10a)),        —S(O)N(R¹⁰R^(10a)), —S(O)₂R¹⁰, —S(O)R¹⁰,        —N(R¹⁰)S(O)₂N(R^(10a)R^(10b)), —SR¹⁰, —N(R¹⁰R^(10a)), —NO₂,        —OC(O)R¹⁰, —N(R¹⁰)C(O)R^(10a), —N(R¹⁰)S(O)₂R^(10a),        —N(R¹⁰)S(O)R^(10a), —N(R¹⁰)C(O)OR^(10a),        —N(R¹⁰)C(O)N(R^(10a)R^(10b)), —OC(O)N(R¹⁰R^(10a)), -T, C₁₋₂₀        alkyl, C₂₋₂₀ alkenyl, and C₂₋₂₀ alkynyl; wherein -T, C₁₋₂₀        alkyl, C₂₋₂₀ alkenyl, and C₂₋₂₀ alkynyl are optionally        substituted with one or more —R¹¹, which are the same or        different and wherein C₁₋₂₀ alkyl, C₂₋₂₀ alkenyl, and C₂₋₂₀        alkynyl are optionally interrupted by one or more groups        selected from the group consisting of -T-, —C(O)O—, —O—, —C(O)—,        —C(O)N(R¹²)—, —S(O)₂N(R¹²)—, —S(O)N(R¹²)—, —S(O)₂—, —S(O)—,        —N(R¹²)S(O)₂N(R^(12a))—, —S—, —N(R¹²)—, —OC(OR¹²)(R^(12a))—,        —N(R¹²)C(O)N(R^(12a))—, and —OC(O)N(R¹²)—;    -   each —R¹⁰, —R^(10a), —R^(10b) is independently selected from the        group consisting of —H, -T, C₁₋₂₀ alkyl, C₂₋₂₀ alkenyl, and        C₂₋₂₀ alkynyl; wherein -T, C₁₋₂₀ alkyl, C₂₋₂₀ alkenyl, and C₂₋₂₀        alkynyl are optionally substituted with one or more —R¹¹, which        are the same or different and wherein C₁₋₂₀ alkyl, C₂₋₂₀        alkenyl, and C₂₋₂₀ alkynyl are optionally interrupted by one or        more groups selected from the group consisting of -T-, —C(O)O—,        —O—, —C(O)—, —C(O)N(R¹²)—, —S(O)₂N(R¹²)—, —S(O)N(R¹²)—, —S(O)₂—,        —S(O)—, —N(R¹²)S(O)₂N(R^(12a))—, —S—, —N(R¹²)—,        —OC(OR¹²)(R^(12a))—, —N(R¹²)C(O)N(R^(12a))—, and —OC(O)N(R¹²)—;    -   each T is independently of each other selected from the group        consisting of phenyl, naphthyl, indenyl, indanyl, tetralinyl,        C₃₋₁₀ cycloalkyl, 3- to 10-membered heterocyclyl, and 8- to        11-membered heterobicyclyl; wherein each T is independently        optionally substituted with one or more —R¹¹, which are the same        or different;    -   each —R¹¹ is independently of each other selected from halogen,        —CN, oxo (═O), —COOR¹³, —OR¹³, —C(O)R¹³, —C(O)N(R¹³R^(13a)),        —S(O)₂N(R¹³R^(13a)), —S(O)N(R¹³R^(13a)), —S(O)₂R¹³, —S(O)R¹³,        —N(R¹³)S(O)₂N(R^(13a)R^(13b)), —SR¹³, —N(R¹³R^(13a)), —NO₂,        —OC(O)R¹³, —N(R¹³)C(O)R^(13a), —N(R¹³)S(O)₂R^(13a),        —N(R¹³)S(O)R^(13a), —N(R¹³)C(O)OR^(13a),        —N(R¹³)C(O)N(R^(13a)R^(13b)), —OC(O)N(R¹³R^(13a)), and C₁₋₆        alkyl; wherein C₁₋₆ alkyl is optionally substituted with one or        more halogen, which are the same or different;    -   each —R¹², —R^(12a), —R¹³, —R^(13a), —R^(13b) is independently        selected from the group consisting of —H, and C₁₋₆ alkyl;        wherein C₁₋₆ alkyl is optionally substituted with one or more        halogen, which are the same or different;    -   optionally, one or more of the pairs —R¹/—R^(1a), —R²/—R^(2a),        —R³/—R^(3a), —R⁶/—R^(6a), —R⁷/—R^(7a) are joined together with        the atom to which they are attached to form a C₃₋₁₀ cycloalkyl        or a 3- to 10-membered heterocyclyl;    -   optionally, one or more of the pairs —R¹/—R², —R¹/—R³, —R¹/—R⁴,        —R¹/—R⁵, —R¹/—R⁶, —R¹/—R⁷, —R²/—R³, —R²/—R⁴, —R²/—R⁵, —R²/—R⁶,        —R²/—R⁷, —R³/—R⁴, —R³/—R⁵, —R³/—R⁶, —R³/—R⁷, —R⁴/—R⁵, —R⁴/—R⁶,        —R⁴/—R⁷, —R⁵/—R⁶, —R⁵/—R⁷, —R⁶/—R⁷ are joint together with the        atoms to which they are attached to form a ring A;    -   A is selected from the group consisting of phenyl; naphthyl;        indenyl; indanyl; tetralinyl; C₃₋₁₀ cycloalkyl; 3- to        10-membered heterocyclyl; and 8- to 11-membered heterobicyclyl;    -   wherein -L¹- is substituted with -L²-Z or -L²-Z′ and wherein        -L¹- is optionally further substituted;        -   wherein        -   -L²- is a single chemical bond or a spacer;        -   —Z is a water-soluble carrier; and        -   —Z′ is a water-insoluble carrier.

The optional further substituents of -L¹- of formula (III) arepreferably as described above.

Preferably -L¹- of formula (III) is substituted with one moiety -L²-Z or-L²-Z′.

In one embodiment -L¹- of formula (III) is not further substituted.

Additional preferred embodiments for -L¹- are disclosed in EP1536334B1,WO2009/009712A1, WO2008/034122A1, WO2009/143412A2, WO2011/082368A2, andU.S. Pat. No. 8,618,124B2, which are herewith incorporated by referencein their entirety.

Additional preferred embodiments for -L¹- are disclosed in U.S. Pat. No.8,946,405B2 and U.S. Pat. No. 8,754,190B2, which are herewithincorporated by reference in their entirety. Accordingly, a preferredmoiety -L¹- is of formula (IV):

-   -   wherein    -   the dashed line indicates attachment to -D which is a PTH moiety        and wherein attachment is through a functional group of -D        selected from the group consisting of —OH, —SH and —NH₂;    -   m is 0 or 1;    -   at least one or both of —R¹ and —R² is/are independently of each        other selected from the group consisting of —CN, —NO₂,        optionally substituted aryl, optionally substituted heteroaryl,        optionally substituted alkenyl, optionally substituted alkynyl,        —C(O)R³, —S(O)R³, —S(O)₂R³, and —SR⁴,    -   one and only one of —R¹ and —R² is selected from the group        consisting of —H, optionally substituted alkyl, optionally        substituted arylalkyl, and optionally substituted        heteroarylalkyl;    -   —R³ is selected from the group consisting of —H, optionally        substituted alkyl, optionally substituted aryl, optionally        substituted arylalkyl, optionally substituted heteroaryl,        optionally substituted heteroarylalkyl, —OR⁹ and —N(R⁹)₂;    -   —R⁴ is selected from the group consisting of optionally        substituted alkyl, optionally substituted aryl, optionally        substituted arylalkyl, optionally substituted heteroaryl, and        optionally substituted heteroarylalkyl;    -   each —R⁵ is independently selected from the group consisting of        —H, optionally substituted alkyl, optionally substituted        alkenylalkyl, optionally substituted alkynylalkyl, optionally        substituted aryl, optionally substituted arylalkyl, optionally        substituted heteroaryl and optionally substituted        heteroarylalkyl;    -   —R⁹ is selected from the group consisting of —H and optionally        substituted alkyl;    -   —Y— is absent and —X— is —O— or —S—; or    -   —Y— is —N(Q)CH₂— and —X— is —O—;    -   Q is selected from the group consisting of optionally        substituted alkyl, optionally substituted aryl, optionally        substituted arylalkyl, optionally substituted heteroaryl and        optionally substituted heteroarylalkyl;    -   optionally, —R¹ and —R² may be joined to form a 3 to 8-membered        ring; and    -   optionally, both —R⁹ together with the nitrogen to which they        are attached form a heterocyclic ring;    -   wherein -L¹- is substituted with -L²-Z or -L²-Z′ and wherein        -L¹- is optionally further substituted;        -   wherein        -   -L²- is a single chemical bond or a spacer;        -   —Z is a water-soluble carrier; and        -   Z′ is a water-insoluble carrier.

Only in the context of formula (IV) the terms used have the followingmeaning:

The term “alkyl” as used herein includes linear, branched or cyclicsaturated hydrocarbon groups of 1 to 8 carbons, or in some embodiments 1to 6 or 1 to 4 carbon atoms.

The term “alkoxy” includes alkyl groups bonded to oxygen, includingmethoxy, ethoxy, isopropoxy, cyclopropoxy, cyclobutoxy, and similar.

The term “alkenyl” includes non-aromatic unsaturated hydrocarbons withcarbon-carbon double bonds.

The term “alkynyl” includes non-aromatic unsaturated hydrocarbons withcarbon-carbon triple bonds.

The term “aryl” includes aromatic hydrocarbon groups of 6 to 18 carbons,preferably 6 to 10 carbons, including groups such as phenyl, naphthyl,and anthracenyl. The term “heteroaryl” includes aromatic ringscomprising 3 to 15 carbons containing at least one N, O or S atom,preferably 3 to 7 carbons containing at least one N, O or S atom,including groups such as pyrrolyl, pyridyl, pyrimidinyl, imidazolyl,oxazolyl, isoxazolyl, thiazolyl, isothiazolyl, quinolyl, indolyl,indenyl, and similar.

In some instance, alkenyl, alkynyl, aryl or heteroaryl moieties may becoupled to the remainder of the molecule through an alkylene linkage.Under those circumstances, the substituent will be referred to asalkenylalkyl, alkynylalkyl, arylalkyl or heteroarylalkyl, indicatingthat an alkylene moiety is between the alkenyl, alkynyl, aryl orheteroaryl moiety and the molecule to which the alkenyl, alkynyl, arylor heteroaryl is coupled.

The term “halogen” includes bromo, fluoro, chloro and iodo.

The term “heterocyclic ring” refers to a 4 to 8 membered aromatic ornon-aromatic ring comprising 3 to 7 carbon atoms and at least one N, O,or S atom. Examples are piperidinyl, piperazinyl, tetrahydropyranyl,pyrrolidine, and tetrahydrofuranyl, as well as the exemplary groupsprovided for the term “heteroaryl” above.

When a ring system is optionally substituted, suitable substituents areselected from the group consisting of alkyl, alkenyl, alkynyl, or anadditional ring, each optionally further substituted.

Optional substituents on any group, including the above, include halo,nitro, cyano, —OR, —SR, —NR₂, —OCOR, —NRCOR, —COOR, —CONR₂, —SOR, —SO₂R,—SONR₂, —SO₂N R₂, wherein each R is independently alkyl, alkenyl,alkynyl, aryl or heteroaryl, or two R groups taken together with theatoms to which they are attached form a ring.

Preferably -L¹- of formula (IV) is substituted with one moiety -L²-Z or-L²-Z′.

An additional preferred embodiment for -L¹- is disclosed inWO02013/036857A1, which is herewith incorporated by reference in itsentirety. Accordingly, a preferred moiety -L¹- is of formula (V):

-   -   wherein    -   the dashed line indicates attachment to -D which is a PTH moiety        and wherein attachment is through an amine functional group of        -D;    -   —R¹ is selected from the group consisting of optionally        substituted C₁-C₆ linear, branched, or cyclic alkyl; optionally        substituted aryl; optionally substituted heteroaryl; alkoxy; and        —NR⁵ ₂;    -   —R² is selected from the group consisting of —H; optionally        substituted C₁-C₆ alkyl; optionally substituted aryl; and        optionally substituted heteroaryl;    -   —R³ is selected from the group consisting of —H; optionally        substituted C₁-C₆ alkyl; optionally substituted aryl; and        optionally substituted heteroaryl;        -   —R⁴ is selected from the group consisting of —H; optionally            substituted C₁-C₆ alkyl; optionally substituted aryl; and            optionally substituted heteroaryl;    -   each —R⁵ is independently of each other selected from the group        consisting of —H; optionally substituted C₁-C₆ alkyl; optionally        substituted aryl; and optionally substituted heteroaryl; or when        taken together two —R⁵ can be cycloalkyl or cycloheteroalkyl;    -   wherein -L¹- is substituted with -L²-Z or -L²-Z′ and wherein        -L¹- is optionally further substituted;        -   wherein        -   -L²- is a single chemical bond or a spacer;        -   —Z is a water-soluble carrier; and        -   —Z′ is a water-insoluble carrier.

Only in the context of formula (V) the terms used have the followingmeaning:

“Alkyl”, “alkenyl”, and “alkynyl” include linear, branched or cyclichydrocarbon groups of 1-8 carbons or 1-6 carbons or 1-4 carbons whereinalkyl is a saturated hydrocarbon, alkenyl includes one or morecarbon-carbon double bonds and alkynyl includes one or morecarbon-carbon triple bonds. Unless otherwise specified these contain 1-6C.

“Aryl” includes aromatic hydrocarbon groups of 6-18 carbons, preferably6-10 carbons, including groups such as phenyl, naphthyl, and anthracene“Heteroaryl” includes aromatic rings comprising 3-15 carbons containingat least one N, O or S atom, preferably 3-7 carbons containing at leastone N, O or S atom, including groups such as pyrrolyl, pyridyl,pyrimidinyl, imidazolyl, oxazolyl, isoxazolyl, thiazolyl, isothiazolyl,quinolyl, indolyl, indenyl, and similar.

The term “substituted” means an alkyl, alkenyl, alkynyl, aryl, orheteroaryl group comprising one or more substituent groups in place ofone or more hydrogen atoms. Substituents may generally be selected fromhalogen including F, Cl, Br, and I; lower alkyl including linear,branched, and cyclic; lower haloalkyl including fluoroalkyl,chloroalkyl, bromoalkyl, and iodoalkyl; OH; lower alkoxy includinglinear, branched, and cyclic; SH; lower alkylthio including linear,branched and cyclic; amino, alkylamino, dialkylamino, silyl includingalkylsilyl, alkoxysilyl, and arylsilyl; nitro; cyano; carbonyl;carboxylic acid, carboxylic ester, carboxylic amide, aminocarbonyl;aminoacyl; carbamate; urea; thiocarbamate; thiourea; ketne; sulfone;sulfonamide; aryl including phenyl, naphthyl, and anthracenyl;heteroaryl including 5-member heteroaryls including as pyrrole,imidazole, furan, thiophene, oxazole, thiazole, isoxazole, isothiazole,thiadiazole, triazole, oxadiazole, and tetrazole, 6-member heteroarylsincluding pyridine, pyrimidine, pyrazine, and fused heteroarylsincluding benzofuran, benzothiophene, benzoxazole, benzimidazole,indole, benzothiazole, benzisoxazole, and benzisothiazole.

Preferably -L¹- of formula (V) is substituted with one moiety -L²-Z or-L²-Z′.

A further preferred embodiment for -L¹- is disclosed in U.S. Pat. No.7,585,837B2, which is herewith incorporated by reference in itsentirety. Accordingly, a preferred moiety -L¹- is of formula (VI):

-   -   wherein    -   the dashed line indicates attachment to -D which is a PTH moiety        and wherein attachment is through an amine functional group of        -D;    -   R¹ and R² are independently selected from the group consisting        of hydrogen, alkyl, alkoxy, alkoxyalkyl, aryl, alkaryl, aralkyl,        halogen, nitro, —SO₃H, —SO₂NHR⁵, amino, ammonium, carboxyl,        PO₃H₂, and OPO₃H₂;    -   R³, R⁴, and R⁵ are independently selected from the group        consisting of hydrogen, alkyl, and aryl;    -   wherein -L¹- is substituted with -L²-Z or -L²-Z′ and wherein        -L¹- is optionally further substituted;        -   wherein        -   -L²- is a single chemical bond or a spacer;        -   —Z is a water-soluble carrier; and        -   —Z′ is a water-insoluble carrier.

Suitable substituents for formulas (VI) are alkyl (such as C₁₋₆ alkyl),alkenyl (such as C₂₋₆ alkenyl), alkynyl (such as C₂₋₆ alkynyl), aryl(such as phenyl), heteroalkyl, heteroalkenyl, heteroalkynyl, heteroaryl(such as aromatic 4 to 7 membered heterocycle) or halogen moieties.

Only in the context of formula (VI) the terms used have the followingmeaning:

The terms “alkyl”, “alkoxy”, “alkoxyalkyl”, “aryl”, “alkaryl” and“aralkyl” mean alkyl radicals of 1-8, preferably 1-4 carbon atoms, e.g.methyl, ethyl, propyl, isopropyl and butyl, and aryl radicals of 6-10carbon atoms, e.g. phenyl and naphthyl. The term “halogen” includesbromo, fluoro, chloro and iodo.

Preferably -L¹- of formula (VI) is substituted with one moiety -L²-Z or-L²-Z′.

A further preferred embodiment for -L¹- is disclosed in WO2002/089789A1,which is herewith incorporated by reference in its entirety.Accordingly, a preferred moiety -L¹- is of formula (VII):

-   -   wherein    -   the dashed line indicates attachment to -D which is a PTH moiety        and wherein attachment is through an amine functional group of        -D;    -   L₁ is a bifunctional linking group,    -   Y₁ and Y₂ are independently O, S or NR⁷;    -   R², R³, R⁴, R⁵, R⁶ and R⁷ are independently selected from the        group consisting of hydrogen, C₁₋₆ alkyls, C₃₋₁₂ branched        alkyls, C₃₋₈ cycloalkyls, C₁₋₆ substituted alkyls, C₃₋₈        substituted cycloalkyls, aryls, substituted aryls, aralkyls,        C₁₋₆ heteroalkyls, substituted C₁₋₆ heteroalkyls, C₁₋₆ alkoxy,        phenoxy, and C₁₋₆ heteroalkoxy;    -   Ar is a moiety which when included in formula (VII) forms a        multisubstituted aromatic hydrocarbon or a multi-substituted        heterocyclic group;    -   X is a chemical bond or a moiety that is actively transported        into a target cell, a hydrophobic moiety, or a combination        thereof,    -   y is 0 or 1;    -   wherein -L¹- is substituted with -L²-Z or -L²-Z′ and wherein        -L¹- is optionally further substituted;        -   wherein        -   -L²- is a single chemical bond or a spacer;        -   —Z is a water-soluble carrier; and        -   —Z′ is a water-insoluble carrier.

Only in the context of formula (VII) the terms used have the followingmeaning:

The term “alkyl” shall be understood to include, e.g. straight,branched, substituted C₁₋₁₂ alkyls, including alkoxy, C₃₋₈ cycloalkylsor substituted cycloalkyls, etc.

The term “substituted” shall be understood to include adding orreplacing one or more atoms contained within a functional group orcompounds with one or more different atoms.

Substituted alkyls include carboxyalkyls, aminoalkyls, dialkylaminos,hydroxyalkyls and mercaptoalkyls; substituted cycloalkyls includemoieties such as 4-chlorocyclohexyl; aryls include moieties such asnapthyl; substituted aryls include moieties such as 3-bromo-phenyl;aralkyls include moieties such as toluyl; heteroalkyls include moietiessuch as ethylthiophene; substituted heteroalkyls include moieties suchas 3-methoxythiophone; alkoxy includes moieties such as methoxy; andphenoxy includes moieties such as 3-nitrophenoxy. Halo-shall beunderstood to include fluoro, chloro, iodo and bromo.

Preferably -L¹- of formula (VII) is substituted with one moiety -L²-Z or-L²-Z′.

In another preferred embodiment -L¹- comprises a substructure of formula(VIII)

-   -   wherein    -   the dashed line marked with the asterisk indicates attachment to        a nitrogen of -D which is a PTH moiety by forming an amide bond;    -   the unmarked dashed lines indicate attachment to the remainder        of -L¹-; and    -   wherein -L¹- is substituted with -L²-Z or -L²-Z′ and wherein        -L¹- is optionally further substituted;        -   wherein        -   -L²- is a single chemical bond or a spacer;        -   —Z is a water-soluble carrier; and        -   —Z′ is a water-insoluble carrier.

Preferably -L¹- of formula (VIII) is substituted with one moiety -L²-Zor -L²-Z′.

In one embodiment -L¹- of formula (VIII) is not further substituted.

In another preferred embodiment -L¹- comprises a substructure of formula(IX)

-   -   wherein    -   the dashed line marked with the asterisk indicates attachment to        a nitrogen of -D which is a PTH moiety by forming a carbamate        bond;    -   the unmarked dashed lines indicate attachment to the remainder        of -L¹-; and    -   wherein -L¹- is substituted with -L²-Z or -L²-Z′ and wherein        -L¹- is optionally further substituted;        -   wherein        -   -L²- is a single chemical bond or a spacer;        -   —Z is a water-soluble carrier; and        -   —Z′ is a water-insoluble carrier.

Preferably -L¹- of formula (IX) is substituted with one moiety -L²-Z or-L²-Z′.

In one embodiment -L¹- of formula (IX) is not further substituted.

In the prodrugs of the present invention -L²- is a chemical bond or aspacer moiety.

In one embodiment -L²- is a chemical bond.

In another embodiment -L²- is a spacer moiety.

When -L²- is other than a single chemical bond, -L²- is preferablyselected from the group consisting of -T-, —C(O)O—, —O—, —C(O)—,—C(O)N(R^(y1))—, —S(O)₂N(R^(y1))—, —S(O)N(R^(y1))—, —S(O)₂—, —S(O)—,—N(R^(y1))S(O)₂N(R^(y1a))—, —S—, —N(R^(y1))—, —OC(OR^(y1))(R^(y1a))—,—N(R^(y1))C(O)N(R^(1a))—, —OC(O)N(R^(y1))—, C₁₋₅₀ alkyl, C₂₋₅₀ alkenyl,and C₂₋₅₀ alkynyl; wherein -T-, C₁₋₅₀ alkyl, C₂₋₅₀ alkenyl, and C₂₋₅₀alkynyl are optionally substituted with one or more —R^(y2), which arethe same or different and wherein C₁₋₅₀ alkyl, C₂₋₅₀ alkenyl, and C₂₋₅₀alkynyl are optionally interrupted by one or more groups selected fromthe group consisting of -T-, —C(O)O—, —O—, —C(O)—, —C(O)N(R^(y3))—,—S(O)₂N(R^(y3))—, —S(O)N(R^(y3))—, —S(O)₂—, —S(O)—,—N(R^(y3))S(O)₂N(R^(y3a))—, —S—, —N(R^(y3))—, —OC(OR^(y3))(R^(y3a))—,—N(R^(y3))C(O)N(R^(y3a))_, and —OC(O)N(R^(y3))—;

—R^(y1) and —R^(y1a) are independently of each other selected from thegroup consisting of —H, -T, C₁₋₅₀ alkyl, C₂₋₅₀ alkenyl, and C₂₋₅₀alkynyl; wherein -T, C₁₋₅₀ alkyl, C₂₋₅₀ alkenyl, and C₂₋₅₀ alkynyl areoptionally substituted with one or more —R^(y2), which are the same ordifferent, and wherein C₁₋₅₀ alkyl, C₂₋₅₀ alkenyl, and C₂₋₅₀ alkynyl areoptionally interrupted by one or more groups selected from the groupconsisting of -T-, —C(O)O—, —O—, —C(O)—, —C(O)N(R^(y4))—,—S(O)₂N(R^(y4))—, —S(O)N(R^(y4))—, —S(O)₂—, —S(O)—,—N(R^(y4))S(O)₂N(R^(y4a))—, —S—, —N(R^(y4))—, —OC(OR^(y4))(R^(y4a))—,—N(R^(y4))C(O)N(R^(y4a))—, and —OC(O)N(R^(y4))—;

each T is independently selected from the group consisting of phenyl,naphthyl, indenyl, indanyl, tetralinyl, C₃₋₁₀ cycloalkyl, 3- to10-membered heterocyclyl, 8- to 11-membered heterobicyclyl, 8- to30-membered carbopolycyclyl, and 8- to 30-membered heteropolycyclyl;wherein each T is independently optionally substituted with one or more—R^(y2), which are the same or different;

each —R^(y2) is independently selected from the group consisting ofhalogen, —CN, oxo (═O), —COOR^(y5), —OR^(y5), —C(O)R^(y5),—C(O)N(R^(y5)R^(y5a)), —S(O)₂N(R^(y5)R^(y5a)), —S(O)N(R^(y5)R^(y5a)),—S(O)₂R^(y5), —S(O)R^(y5), —N(R^(y5))S(O)₂N(R^(y5a)R^(y5b)), —SR^(y5),—N(R^(y5)R^(y5a)), —NO₂, —OC(O)R^(y5), —N(R^(y5))C(O)R^(y5a),—N(R^(y5))S(O)₂R^(y5a), —N(R⁵)S(O)R^(y5a), —N(R^(y5))C(O)OR^(y5a),—N(R^(y5))C(O)N(R^(5a)R^(y5b)), —OC(O)N(R^(y5)R^(y5a)), and C₁₋₆ alkyl;wherein C₁₋₆ alkyl is optionally substituted with one or more halogen,which are the same or different; and

each —R^(y3), —R^(y3a), —R^(y4), —R^(y4a), —R^(y5), —R^(y5a) and—R^(y5b) is independently selected from the group consisting of —H, andC₁₋₆ alkyl, wherein C₁₋₆ alkyl is optionally substituted with one ormore halogen, which are the same or different.

When -L²- is other than a single chemical bond, -L²- is even morepreferably selected from -T-, —C(O)O—, —O—, —C(O)—, —C(O)N(R^(y1))—,—S(O)₂N(R^(y1))—, —S(O)N(R^(y1))—, —S(O)₂—, —S(O)—,—N(R¹¹)S(O)₂N(R^(y1a))—, —S—, —N(R^(y1))—, —OC(OR^(y1))(R^(y1a))—,—N(R^(y1))C(O)N(R^(y1a))—, —OC(O)N(R^(y1))—, C₁₋₅ alkyl, C₂₋₅₀ alkenyl,and C₂₋₅₀ alkynyl; wherein -T-, C₁₋₂₀ alkyl, C₂₋₂₀ alkenyl, and C₂₋₂₀alkynyl are optionally substituted with one or more —R^(y2), which arethe same or different and wherein C₁₋₂₀ alkyl, C₂₋₂₀ alkenyl, and C₂₋₂₀alkynyl are optionally interrupted by one or more groups selected fromthe group consisting of -T-, —C(O)O—, —O—, —C(O)—, —C(O)N(R^(y3))—,—S(O)₂N(R^(y3))—, —S(O)N(R^(y3))—, —S(O)₂—, —S(O)—,—N(R^(y3))S(O)₂N(R^(y3a))—, —S—, —N(R^(y3))—, —OC(OR^(y3))(R^(y3a))—,—N(R^(y3))C(O)N(R^(y3a))—, and —OC(O)N(R^(y3))—;

—R^(y1) and —R^(y1a) are independently of each other selected from thegroup consisting of —H, -T, C₁₋₁₀ alkyl, C₂₋₁₀ alkenyl, and C₂₋₁₀alkynyl; wherein -T, C₁₋₁₀ alkyl, C₂₋₁₀ alkenyl, and C₂₋₁₀ alkynyl areoptionally substituted with one or more —R^(y2), which are the same ordifferent, and wherein C₁₋₁₀ alkyl, C₂₋₁₀ alkenyl, and C₂₋₁₀ alkynyl areoptionally interrupted by one or more groups selected from the groupconsisting of -T-, —C(O)O—, —O—, —C(O)—, —C(O)N(R^(y4))—,—S(O)₂N(R^(y4))—, —S(O)N(R^(y4))—, —S(O)₂—, —S(O)—,—N(R^(y4))S(O)₂N(R^(y4a))—, —S—, —N(R^(y4))—, —OC(OR^(y4))(R^(y4a))—,—N(R^(y4))C(O)N(R^(y4a))—, and —OC(O)N(R^(y4))—;

each T is independently selected from the group consisting of phenyl,naphthyl, indenyl, indanyl, tetralinyl, C₃₋₁₀ cycloalkyl, 3- to10-membered heterocyclyl, 8- to 11-membered heterobicyclyl, 8- to30-membered carbopolycyclyl, and 8- to 30-membered heteropolycyclyl;wherein each T is independently optionally substituted with one or more—R^(y2), which are the same or different;

—R^(y2) is selected from the group consisting of halogen, —CN, oxo (═O),—COOR^(y5), —OR^(y5), —C(O)R^(y5), —C(O)N(R^(y5)R^(y5a)),—S(O)₂N(R^(y5)R^(y5a)), —S(O)N(R^(y5)R^(y5a)), —S(O)₂R^(y5),—S(O)R^(y5), —N(R^(y5))S(O)₂N(R^(y5a)R^(y5b)), —SR^(y5),—N(R^(y5)R^(y5a)), —NO₂, —OC(O)R^(y5), —N(R^(y5))C(O)R^(y5a),—N(R^(y5))S(O)₂R^(y5a), —N(R^(y5))S(O)R^(y5a), —N(R^(y5))C(O)OR^(y6a),—N(R^(y5))C(O)N(R^(5a)R^(y5b)), —OC(O)N(R^(y5)R^(y5a)), and C₁₋₆ alkyl;wherein C₁₋₆ alkyl is optionally substituted with one or more halogen,which are the same or different; and

each —R^(y3), —R^(y3a), —R^(y4), —R^(y4a), —R^(y5), —R^(y5a) and—R^(y5b) is independently of each other selected from the groupconsisting of —H, and C₁₋₆ alkyl; wherein C₁₋₆ alkyl is optionallysubstituted with one or more halogen, which are the same or different.

When -L²- is other than a single chemical bond, -L²- is even morepreferably selected from the group consisting of -T-, —C(O)O—, —O—,—C(O)—, —C(O)N(R^(y1))—, —S(O)₂N(R^(y1))—, —S(O)N(R^(y1))—, —S(O)₂—,—S(O)—, —N(R^(y1))S(O)₂N(R^(y1a))—, —S—, —N(R^(y1))—,—OC(OR^(y1))(R^(y1a))—, —N(R^(y1))C(O)N(R^(y1a))—, —OC(O)N(R^(y1))—,C₁₋₅₀ alkyl, C₂₋₅₀ alkenyl, and C₂₋₅₀ alkynyl; wherein -T-, C₁₋₅₀ alkyl,C₂₋₅₀ alkenyl, and C₂₋₅₀ alkynyl are optionally substituted with one ormore —R^(y2), which are the same or different and wherein C₁₋₅₀ alkyl,C₂₋₅₀ alkenyl, and C₂₋₅₀ alkynyl are optionally interrupted by one ormore groups selected from the group consisting of -T-, —C(O)O—, —O—,—C(O)—, —C(O)N(R^(y3))—, —S(O)₂N(R^(y3))—, —S(O)N(R^(y3))—, —S(O)₂—,—S(O)—, —N(R^(y3))S(O)₂N(R^(y3a))—, —S—, —N(R^(y3))—,—OC(OR^(y3))(R^(y3a))—, —N(R^(y3))C(O)N(R^(y3)a)_, and —OC(O)N(R^(y3))—;

—R^(y1) and —R^(y1a) are independently selected from the groupconsisting of —H, -T, C₁₋₁₀ alkyl, C₂₋₁₀ alkenyl, and C₂₋₁₀ alkynyl;

each T is independently selected from the group consisting of phenyl,naphthyl, indenyl, indanyl, tetralinyl, C₃₋₁₀ cycloalkyl, 3- to10-membered heterocyclyl, 8- to 11-membered heterobicyclyl, 8- to30-membered carbopolycyclyl, and 8- to 30-membered heteropolycyclyl;

each —R^(y2) is independently selected from the group consisting ofhalogen, and C₁₋₆ alkyl; and

each —R^(y3), —R^(y3a), —R^(y4), —R^(y4a), —R^(y5), —R^(y5a) and—R^(y5b) is independently of each other selected from the groupconsisting of —H, and C₁₋₆ alkyl; wherein C₁₋₆ alkyl is optionallysubstituted with one or more halogen, which are the same or different.

Even more preferably, -L²- is a C₁₋₂₀ alkyl chain, which is optionallyinterrupted by one or more groups independently selected from —O—, -T-and —C(O)N(R^(y1))—; and which C₁₋₂₀ alkyl chain is optionallysubstituted with one or more groups independently selected from —OH, -Tand —C(O)N(R^(y6)R^(y6a)); wherein —R^(y1), —R^(y6), —R^(y6a) areindependently selected from the group consisting of H and C₁₋₄ alkyl andwherein T is selected from the group consisting of phenyl, naphthyl,indenyl, indanyl, tetralinyl, C₃₋₁₀ cycloalkyl, 3- to 10-memberedheterocyclyl, 8- to 11-membered heterobicyclyl, 8- to 30-memberedcarbopolycyclyl, and 8- to 30-membered heteropolycyclyl.

Preferably, -L²- has a molecular weight in the range of from 14 g/mol to750 g/mol.

Preferably, -L²- comprises a moiety selected from

wherein

dashed lines indicate attachment to the rest of -L²-, -L¹-, —Z and/or—Z′, respectively; and

—R and —R^(a) are independently of each other selected from the groupconsisting of —H, methyl, ethyl, propyl, butyl, pentyl and hexyl.

In one preferred embodiment -L²- has a chain lengths of 1 to 20 atoms.

As used herein the term “chain length” with regard to the moiety -L²-refers to the number of atoms of -L²- present in the shortest connectionbetween -L¹- and —Z.

Preferably, -L²- is of formula (i)

-   -   wherein    -   the dashed line marked with the asterisk indicates attachment to        -L¹-;    -   the unmarked dashed line indicates attachment to —Z or —Z′;    -   n is selected from the group consisting of 0, 1, 2, 3, 4, 5, 6,        7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 and 18; and    -   wherein the moiety of formula (i) is optionally further        substituted.

Preferably, n of formula (i) is selected from the group consisting of 3,4, 5, 6, 7, 8, and 9. Even more preferably n of formula (i) is 4, 5, 6,or 7. In one embodiment n of formula (i) is 4. In another embodiment nof formula (i) is 5. In another embodiment n of formula (i) is 6.

In one preferred embodiment the moiety -L -L²- is selected from thegroup consisting of

-   -   wherein    -   the unmarked dashed line indicates the attachment to a nitrogen        of -D which is a PTH moiety by forming an amide bond; and    -   the dashed line marked with the asterisk indicates attachment to        —Z or —Z′.

In one preferred embodiment the moiety -L-L²- is selected from the groupconsisting of

-   -   wherein    -   the unmarked dashed line indicates the attachment to a nitrogen        of -D which is a PTH moiety by forming an amide bond; and    -   the dashed line marked with the asterisk indicates attachment to        —Z or —Z′.

In a preferred embodiment the moiety -L¹-L²- is of formula (IIca-ii).

In another preferred embodiment the moiety -L -L²⁻ is of formula(IIcb-iii).

Preferably, the controlled-release PTH compound of the present inventionis of formula (Ia) with x=1.

The carrier —Z comprises a C₈₋₂₄ alkyl or a polymer. Preferably, —Zcomprises a polymer, preferably a polymer selected from the groupconsisting of 2-methacryloyl-oxyethyl phosphoyl cholins, poly(acrylicacids), poly(acrylates), poly(acrylamides), poly(alkyloxy) polymers,poly(amides), poly(amidoamines), poly(amino acids), poly(anhydrides),poly(aspartamides), poly(butyric acids), poly(glycolic acids),polybutylene terephthalates, poly(caprolactones), poly(carbonates),poly(cyanoacrylates), poly(dimethylacrylamides), poly(esters),poly(ethylenes), poly(ethyleneglycols), poly(ethylene oxides),poly(ethyl phosphates), poly(ethyloxazolines), poly(glycolic acids),poly(hydroxyethyl acrylates), poly(hydroxyethyl-oxazolines),poly(hydroxymethacrylates), poly(hydroxypropylmethacrylamides),poly(hydroxypropyl methacrylates), poly(hydroxypropyloxazolines),poly(iminocarbonates), poly(lactic acids), poly(lactic-co-glycolicacids), poly(methacrylamides), poly(methacrylates),poly(methyloxazolines), poly(organophosphazenes), poly(ortho esters),poly(oxazolines), poly(propylene glycols), poly(siloxanes),poly(urethanes), poly(vinyl alcohols), poly(vinyl amines),poly(vinylmethylethers), poly(vinylpyrrolidones), silicones, celluloses,carbomethyl celluloses, hydroxypropyl methylcelluloses, chitins,chitosans, dextrans, dextrins, gelatins, hyaluronic acids andderivatives, functionalized hyaluronic acids, mannans, pectins,rhamnogalacturonans, starches, hydroxyalkyl starches, hydroxyethylstarches and other carbohydrate-based polymers, xylans, and copolymersthereof.

Preferably, —Z has a molecular weight ranging from 5 to 200 kDa. Evenmore preferably, —Z has a molecular weight ranging from 8 to 100 kDa,even more preferably ranging from 10 to 80 kDa, even more preferablyfrom 12 to 60, even more preferably from 15 to 40 and most preferably —Zhas a molecular weight of about 20 kDa. In another equally preferredembodiment —Z has a molecular weight of about 40 kDa.

In one embodiment such water-soluble carrier —Z comprises a protein.Preferred proteins are selected from the group consisting ofcarboxyl-terminal polypeptide of the chorionic gonadotropin as describedin US 2012/0035101 A1 which are herewith incorporated by reference;albumin; XTEN sequences as described in WO 2011123813 A2 which areherewith incorporated by reference; proline/alanine random coilsequences as described in WO 2011/144756 A1 which are herewithincorporated by reference; proline/alanine/serine random coil sequencesas described in WO 2008/155134 A1 and WO 2013/024049 A1 which areherewith incorporated by reference; and Fc fusion proteins.

In one embodiment —Z is a polysarcosine.

In another preferred embodiment —Z comprises a poly(N-methylglycine).

In a particularly preferred embodiment —Z comprises a random coilprotein moiety.

In one preferred embodiment —Z comprises one random coil protein moiety.

In another preferred embodiment —Z comprises two random coil proteinsmoieties.

In another preferred embodiment —Z comprises three random coil proteinsmoieties.

In another preferred embodiment —Z comprises four random coil proteinsmoieties.

In another preferred embodiment —Z comprises five random coil proteinsmoieties.

In another preferred embodiment —Z comprises six random coil proteinsmoieties.

In another preferred embodiment —Z comprises seven random coil proteinsmoieties.

In another preferred embodiment —Z comprises eight random coil proteinsmoieties.

Preferably such random coil protein moiety comprises at least 25 aminoacid residues and at most 2000 amino acids. Even more preferably suchrandom coil protein moiety comprises at least 30 amino acid residues andat most 1500 amino acid residues. Even more preferably such random coilprotein moiety comprises at least 50 amino acid residues and at most 500amino acid residues.

In a preferred embodiment, —Z comprises a random coil protein moiety ofwhich at least 80%, preferably at least 85%, even more preferably atleast 90%, even more preferably at least 95%, even more preferably atleast 98% and most preferably at least 99% of the total number of aminoacids forming said random coil protein moiety are selected from alanineand proline. Even more preferably, at least 10%, but less than 75%,preferably less than 65%, of the total number of amino acid residues ofsuch random coil protein moiety are proline residues. Preferably, suchrandom coil protein moiety is as described in WO 2011/144756 A1 which ishereby incorporated by reference in its entirety. Even more preferably—Z comprises at least one moiety selected from the group consisting ofSEQ ID NO:1, SEQ ID NO:2, SEQ ID NO:3, SEQ ID NO:4, SEQ ID NO:5, SEQ IDNO:6, SEQ ID NO:7, SEQ ID NO:8, SEQ ID NO:9, SEQ ID NO:10, SEQ ID NO:11,SEQ ID NO:12, SEQ ID NO:13, SEQ ID NO:14, SEQ ID NO:15, SEQ ID NO:16,SEQ ID NO:17, SEQ ID NO:51 and SEQ ID NO:61 as disclosed inWO2011/144756 which are hereby incorporated by reference. A moietycomprising such random coil protein comprising alanine and proline willbe referred to as “PA” or “PA moiety”.

Accordingly, —Z comprises a PA moiety.

In an equally preferred embodiment, —Z comprises a random coil proteinmoiety of which at least 80%, preferably at least 85%, even morepreferably at least 90%, even more preferably at least 95%, even morepreferably at least 98% and most preferably at least 99% of the totalnumber of amino acids forming said random coil protein moiety areselected from alanine, serine and proline. Even more preferably, atleast 4%, but less than 40% of the total number of amino acid residuesof such random coil protein moiety are proline residues. Preferably,such random coil protein moiety is as described in WO 2008/155134 A1which is hereby incorporated by reference in its entirety. Even morepreferably —Z comprises at least one moiety selected from the groupconsisting of SEQ ID NO:2, SEQ ID NO:4, SEQ ID NO:6, SEQ ID NO:8, SEQ IDNO:10, SEQ ID NO:12, SEQ ID NO:14, SEQ ID NO:16, SEQ ID NO:18, SEQ IDNO:20, SEQ ID NO:22, SEQ ID NO:24, SEQ ID NO:26, SEQ ID NO:28, SEQ IDNO:30, SEQ ID NO:32, SEQ ID NO:34, SEQ ID NO:36, SEQ ID NO:40, SEQ IDNO:42, SEQ ID NO:44, SEQ ID NO:46, SEQ ID NO:50, SEQ ID NO:52, SEQ IDNO:54 and SEQ ID NO:56 as disclosed in WO 2008/155134 A1, which arehereby incorporated by reference. A moiety comprising such random coilprotein moiety comprising alanine, serine and proline will be referredto as “PAS” or “PAS moiety”.

Accordingly, —Z comprises a PAS moiety.

In an equally preferred embodiment, —Z comprises a random coil proteinmoiety of which at least 80%, preferably at least 85%, even morepreferably at least 90%, even more preferably at least 95%, even morepreferably at least 98% and most preferably at least 99% of the totalnumber of amino acids forming said random coil protein moiety areselected from alanine, glycine and proline. A moiety comprising suchrandom coil protein moiety comprising alanine, glycine and proline willbe referred to as “PAG” or “PAG moiety”.

Accordingly, —Z comprises a PAG moiety.

In an equally preferred embodiment, —Z comprises a random coil proteinmoiety of which at least 80%, preferably at least 85%, even morepreferably at least 90%, even more preferably at least 95%, even morepreferably at least 98% and most preferably at least 99% of the totalnumber of amino acids forming said random coil protein moiety areselected from proline and glycine. A moiety comprising such random coilprotein moiety comprising proline and glycine will be referred to as“PG” or “PG moiety”.

Preferably, such PG moiety comprises a moiety of formula (a-0)

[(Gly)_(p)-Pro-(Gly)_(q)]_(r) (a-0);

-   -   wherein    -   p is selected from the group consisting of 0, 1, 2, 3, 4 and 5;    -   q is selected from the group consisting of 0, 1, 2, 3, 4 and 5;    -   r is an integer ranging from and including 10 to 1000;    -   provided that at least one of p and q is at least 1;

Preferably, p of formula (a-0) is selected from the group consisting of1, 2 and 3.

Preferably, q of formula (a-0) is selected from 0, 1 and 2.

Even more preferably the PG moiety comprises the sequence of SEQ ID NO:122:

GGPGGPGPGGPGGPGPGGPG

Even more preferably, the PG moiety comprises the sequence of formula(a-0-a)

(GGPGGPGPGGPGGPGPGGPG)_(v) (a-0-a),

-   -   wherein    -   v is an integer ranging from and including 1 to 50.

It is understood that the sequence of formula (a-0-a) comprises vreplicates of the sequence of SEQ ID NO:122.

Accordingly, —Z comprises a PG moiety.

In an equally preferred embodiment, —Z comprises a random coil proteinmoiety of which at least 80%, preferably at least 85%, even morepreferably at least 90%, even more preferably at least 95%, even morepreferably at least 98% and most preferably at least 99% of the totalnumber of amino acids forming said random coil protein moiety areselected from alanine, glycine, serine, threonine, glutamate andproline. Preferably, such random coil protein moiety is as described inWO 2010/091122 A1 which is hereby incorporated by reference. Even morepreferably —Z comprises at least one moiety selected from the groupconsisting of SEQ ID NO:182, SEQ ID NO:183, SEQ ID NO:184; SEQ IDNO:185, SEQ ID NO:186, SEQ ID NO:187, SEQ ID NO:188, SEQ ID NO:189, SEQID NO:190, SEQ ID NO:191, SEQ ID NO:192, SEQ ID NO:193, SEQ ID NO:194,SEQ ID NO:195, SEQ ID NO:196, SEQ ID NO:197, SEQ ID NO:198, SEQ IDNO:199, SEQ ID NO:200, SEQ ID NO:201, SEQ ID NO:202, SEQ ID NO:203, SEQID NO:204, SEQ ID NO:205, SEQ ID NO:206, SEQ ID NO:207, SEQ ID NO:208,SEQ ID NO:209, SEQ ID NO:210, SEQ ID NO:211, SEQ ID NO:212, SEQ IDNO:213, SEQ ID NO:214, SEQ ID NO:215, SEQ ID NO:216, SEQ ID NO:217, SEQID NO:218, SEQ ID NO:219, SEQ ID NO:220, SEQ ID NO:221, SEQ ID NO:759,SEQ ID NO:760, SEQ ID NO:761, SEQ ID NO:762, SEQ ID NO:763, SEQ IDNO:764, SEQ ID NO:765, SEQ ID NO:766, SEQ ID NO:767, SEQ ID NO:768, SEQID NO:769, SEQ ID NO:770, SEQ ID NO:771, SEQ ID NO:772, SEQ ID NO:773,SEQ ID NO:774, SEQ ID NO:775, SEQ ID NO:776, SEQ ID NO:777, SEQ IDNO:778, SEQ ID NO:779, SEQ ID NO:1715, SEQ ID NO:1716, SEQ ID NO:1718,SEQ ID NO:1719, SEQ ID NO:1720, SEQ ID NO:1721 and SEQ ID NO:1722 asdisclosed in WO2010/091122A1, which are hereby incorporated byreference. A moiety comprising such random coil protein moietycomprising alanine, glycine, serine, threonine, glutamate and prolinewill be referred to as “XTEN” or “XTEN moiety” in line with itsdesignation in WO 2010/091122 A1.

Accordingly, —Z comprises an XTEN moiety.

In another preferred embodiment, —Z comprises a fatty acid derivate.Preferred fatty acid derivatives are those disclosed in WO 2005/027978A2 and WO 2014/060512 A1 which are herewith incorporated by reference.

In another preferred embodiment —Z is a hyaluronic acid-based polymer.

In one embodiment —Z is a carrier as disclosed in WO 2012/02047 A1 whichis herewith incorporated by reference.

In another embodiment —Z is a carrier as disclosed in WO 2013/024048 A1which is herewith incorporated by reference.

In another preferred embodiment —Z is a PEG-based polymer, such as alinear, branched or multi-arm PEG-based polymer.

In one embodiment —Z is a linear PEG-based polymer.

In another embodiment —Z is a multi-arm PEG-based polymer. Preferably,—Z is a multi-arm PEG-based polymer having at least 4 PEG-based arms.

Preferably, such multi-arm PEG-based polymer —Z is connected to amultitude of moieties -L²-L¹-D, wherein each moiety -L²-L -D ispreferably connected to the end of an arm, preferably to the end of anarm. Preferably such multi-arm PEG-based polymer —Z is connected to 2,3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 or 16 moieties -L²-L¹-D.Even more preferably such multi-arm PEG-based polymer —Z is connected to2, 3, 4, 6 or 8 moieties -L²-L¹-D. Even more preferably such multi-armPEG-based polymer —Z is connected to 2, 4 or 6 moieties -L²-L¹-D, evenmore preferably such multi-arm PEG-based polymer —Z is connected to 4 or6 moieties -L²-L-D, and most preferably such multi-arm PEG-based polymer—Z is connected to 4 moieties -L²-L -D.

Preferably, such multi-arm PEG-based polymer —Z is a multi-arm PEGderivative as, for instance, detailed in the products list of JenKemTechnology, USA (accessed by download fromhttp://www.jenkemusa.com/Pages/PEGProducts.aspx on Dec. 18, 2014), suchas a 4-arm-PEG derivative, in particular a 4-arm-PEG comprising apentaerythritol core, an 8-arm-PEG derivative comprising a hexaglycerincore, and an 8-arm-PEG derivative comprising a tripentaerythritol core.More preferably, the water-soluble PEG-based carrier —Z comprises amoiety selected from:

a 4-arm PEG Amine comprising a pentaerythritol core:

with n ranging from 20 to 500;

an 8-arm PEG Amine comprising a hexaglycerin core:

with n ranging from 20 to 500; and

R=hexaglycerin or tripentaerythritol core structure; and

a 6-arm PEG Amine comprising a sorbitol or dipentaerythritol core:

with n ranging from 20 to 500; and

R=comprising a sorbitol or dipentaerythritol core;

and wherein dashed lines indicate attachment to the rest of the PTHprodrug.

In a preferred embodiment —Z is a branched PEG-based polymer. In oneembodiment —Z is a branched PEG-based polymer having one, two, three,four, five or six branching points. Preferably, —Z is a branchedPEG-based polymer having one, two or three branching points. In oneembodiment —Z is a branched PEG-based polymer having one branchingpoint. In another embodiment —Z is a branched PEG-based polymer havingtwo branching points. In another embodiment —Z is a branched PEG-basedpolymer having three branching points.

A branching point is preferably selected from the group consisting of—N<, —CH< and >C<.

Preferably, such branched PEG-based moiety —Z has a molecular weight ofat least 10 kDa.

In one embodiment such branched moiety —Z has a molecular weight rangingfrom and including 10 kDa to 500 kDa, more preferably ranging from andincluding 10 kDa to 250 Da, even more preferably ranging from andincluding 10 kDa to 150 kDa, even more preferably ranging from andincluding 12 kDa to 100 kDa and most preferably ranging from andincluding 15 kDa to 80 kDa.

Preferably, such branched moiety —Z has a molecular weight ranging fromand including 10 kDa to 80 kDa. In one embodiment the molecular weightis about 10 kDa. In another embodiment the molecular weight of suchbranched moiety —Z is about 20 kDa. In another embodiment the molecularweight of such branched moiety —Z is about 30 kDa. In another embodimentthe molecular weight of such a branched moiety —Z is about 40 kDa. Inanother embodiment the molecular weight of such a branched moiety —Z isabout 50 kDa. In another embodiment the molecular weight of such abranched moiety —Z is about 60 kDa. In another embodiment the molecularweight of such a branched moiety —Z is about 70 kDa. In anotherembodiment the molecular weight of such a branched moiety —Z is about 80kDa. Most preferably, such branched moiety —Z has a molecular weight ofabout 40 kDa.

Preferably, —Z or —Z′ comprises a moiety

In an equally preferred embodiment —Z comprises an amide bond.

Preferably —Z comprises a moiety of formula (a)

-   -   wherein    -   the dashed line indicates attachment to -L²- or to the remainder        of —Z;    -   BP^(a) is a branching point selected from the group consisting        of —N<, —CR< and >C<;    -   —R is selected from the group consisting of —H and C₁₋₆ alkyl;    -   a is 0 if BP^(a) is —N< or —CR< and n is 1 if BP^(a) is >C<;    -   —S^(a)—, —S^(a′)—, —S^(a″)— and —S^(a′″)— are independently of        each other a chemical bond or are selected from the group        consisting of C₁₋₅₀ alkyl, C₂₋₅₀ alkenyl, and C₂₋₅₀ alkynyl;        wherein C₁₋₅₀ alkyl, C₂₋₅₀ alkenyl, and C₂₋₅₀ alkynyl are        optionally substituted with one or more —R¹, which are the same        or different and wherein C₁₋₅₀ alkyl, C₂₋₅₀ alkenyl, and C₂₋₅₀        alkynyl are optionally interrupted by one or more groups        selected from the group consisting of -T-, —C(O)O—, —O—, —C(O)—,        —C(O)N(R²)—, —S(O)₂N(R²)—, —S(O)N(R²)—, —S(O)₂—, —S(O)—,        —N(R²)S(O)₂N(R^(2a))—, —S—, —N(R²)—, —OC(OR²)(R^(2a))—,        —N(R²)C(O)N(R^(2a))—, and —OC(O)N(R²)—;    -   each -T- is independently selected from the group consisting of        phenyl, naphthyl, indenyl, indanyl, tetralinyl, C₃₋₁₀        cycloalkyl, 3- to 10-membered heterocyclyl, 8- to 11-membered        heterobicyclyl, 8- to 30-membered carbopolycyclyl, and 8- to        30-membered heteropolycyclyl; wherein each -T- is independently        optionally substituted with one or more —R¹, which are the same        or different;    -   each —R¹ is independently selected from the group consisting of        halogen, —CN, oxo (═O), —COOR³, —OR³, —C(O)R³, —C(O)N(R³R^(3a)),        —S(O)₂N(R³R^(3a)), —S(O)N(R³R^(3a)), —S(O)₂R³, —S(O)R³,        —N(R³)S(O)₂N(R^(3a)R^(3b)), —SR³, —N(R³R^(3a)), —NO₂, —OC(O)R³,        —N(R³)C(O)R^(3a), —N(R³)S(O)₂R^(3a), —N(R³)S(O)R^(3a),        —N(R³)C(O)OR^(3a), —N(R³)C(O)N(R^(3a)R^(3b)), —OC(O)N(R³R^(3a)),        and C₁₋₆ alkyl; wherein C₁₋₆ alkyl is optionally substituted        with one or more halogen, which are the same or different; each        —R², —R^(2a), —R³, —R^(3a) and —R^(3b) is independently selected        from the group consisting of —H, and C₁₋₆ alkyl, wherein C₁₋₆        alkyl is optionally substituted with one or more halogen, which        are the same or different; and —P^(a′), —P^(a″) and —P^(a′″) are        independently a polymeric moiety.

In one embodiment BP^(a) of formula (a) is —N<.

In another embodiment BP^(a) of formula (a) is >C<.

In a preferred embodiment BP^(a) of formula (a) is —CR<. Preferably, —Ris —H. Accordingly, a of formula (a) is 0.

In one embodiment —S^(a)— of formula (a) is a chemical bond.

In another embodiment —S^(a)— of formula (a) is selected from the groupconsisting of C₁₋₁₀ alkyl, C₂₋₁₀ alkenyl and C₂₋₁₀ alkynyl, which C₁₋₁₀alkyl, C₂₋₁₀ alkenyl and C₂₋₁₀ alkynyl are optionally interrupted by oneor more chemical groups selected from the group consisting of -T-,—C(O)O—, —O—, —C(O)—, —C(O)N(R⁴)—, —S(O)₂N(R⁴)—, —S(O)N(R⁴)—, —S(O)₂—,—S(O)—, —N(R⁴)S(O)₂N(R^(4a))—, —S—, —N(R⁴)—, —OC(OR⁴)(R^(4a))—,—N(R⁴)C(O)N(R^(4a))—, and —OC(O)N(R⁴)—; wherein -T- is a 3- to10-membered heterocyclyl; and —R⁴ and —R^(4a) are independently selectedfrom the group consisting of —H, methyl, ethyl, propyl and butyl.

Preferably —S^(a)— of formula (a) is selected from the group consistingof C₁₋₁₀ alkyl which is interrupted by one or more chemical groupsselected from the group consisting of -T-, —C(O)N(R⁴)— and —O—.

In one embodiment —S^(a)— of formula (a) is a chemical bond.

In another embodiment —S^(a′)— of formula (a) is selected from the groupconsisting of C₁₋₁₀ alkyl, C₂₋₁₀ alkenyl and C₂₋₁₀ alkynyl, which C₁₋₁₀alkyl, C₂₋₁₀ alkenyl and C₂₋₁₀ alkynyl are optionally interrupted by oneor more chemical groups selected from the group consisting of —C(O)O—,—O—, —C(O)—, —C(O)N(R⁴)—, —S(O)₂N(R⁴)—, —S(O)N(R⁴)—, —S(O)₂—, —S(O)—,—N(R⁴)S(O)₂N(R^(4a))—, —S—, —N(R⁴)—, —OC(OR⁴)(R^(4a))—,—N(R⁴)C(O)N(R^(4a))—, and —OC(O)N(R⁴)—; wherein —R⁴ and —R^(4a) areindependently selected from the group consisting of —H, methyl, ethyl,propyl and butyl. Preferably —S^(a′)— of formula (a) is selected fromthe group consisting of methyl, ethyl, propyl, butyl, which areoptionally interrupted by one or more chemical groups selected from thegroup consisting of —O—, —C(O)— and —C(O)N(R⁴)—.

In one embodiment —S^(a″)— of formula (a) is a chemical bond.

In another embodiment —S^(a″)— of formula (a) is selected from the groupconsisting of C₁₋₁₀ alkyl, C₂₋₁₀ alkenyl and C₂₋₁₀ alkynyl, which C₁₋₁₀alkyl, C₂₋₁₀ alkenyl and C₂₋₁₀ alkynyl are optionally interrupted by oneor more chemical groups selected from the group consisting of —C(O)O—,—O—, —C(O)—, —C(O)N(R⁴)—, —S(O)₂N(R⁴)—, —S(O)N(R⁴)—, —S(O)₂—, —S(O)—,—N(R⁴)S(O)₂N(R^(4a))—, —S—, —N(R⁴)—, —OC(OR₄)(R^(4a))—,—N(R⁴)C(O)N(R^(4a))—, and —OC(O)N(R⁴)—; wherein —R⁴ and —R^(4a) areindependently selected from the group consisting of —H, methyl, ethyl,propyl and butyl. Preferably —S^(a″)— of formula (a) is selected fromthe group consisting of methyl, ethyl, propyl, butyl, which areoptionally interrupted by one or more chemical groups selected from thegroup consisting of —O—, —C(O)— and —C(O)N(R⁴)—.

In one embodiment —S^(a′″)— of formula (a) is a chemical bond.

In another embodiment —S^(a′″)— of formula (a) is selected from thegroup consisting of C₁₋₁₀ alkyl, C₂₋₁₀ alkenyl and C₂₋₁₀ alkynyl, whichC₁₋₁₀ alkyl, C₂₋₁₀ alkenyl and C₂₋₁₀ alkynyl are optionally interruptedby one or more chemical groups selected from the group consisting of—C(O)O—, —O—, —C(O)—, —C(O)N(R⁴)—, —S(O)₂N(R⁴)—, —S(O)N(R⁴)—, —S(O)₂—,—S(O)—, —N(R⁴)S(O)₂N(R^(4a))—, —S—, —N(R⁴)—, —OC(OR⁴)(R^(4a))—,—N(R⁴)C(O)N(R^(4a))—, and —OC(O)N(R⁴)—; wherein —R⁴ and —R^(4a) areindependently selected from the group consisting of —H, methyl, ethyl,propyl and butyl. Preferably —S^(a′″)— of formula (a) is selected fromthe group consisting of methyl, ethyl, propyl, butyl, which areoptionally interrupted by one or more chemical groups selected from thegroup consisting of —O—, —C(O)— and —C(O)N(R⁴)—.

Preferably, —P^(a′), —P^(a″) and —P^(a′″) of formula (a) independentlycomprise a polymer selected from the group consisting of2-methacryloyl-oxyethyl phosphoyl cholins, poly(acrylic acids),poly(acrylates), poly(acrylamides), poly(alkyloxy) polymers,poly(amides), poly(amidoamines), poly(amino acids), poly(anhydrides),poly(aspartamides), poly(butyric acids), poly(glycolic acids),polybutylene terephthalates, poly(caprolactones), poly(carbonates),poly(cyanoacrylates), poly(dimethylacrylamides), poly(esters),poly(ethylenes), poly(ethyleneglycols), poly(ethylene oxides),poly(ethyl phosphates), poly(ethyloxazolines), poly(glycolic acids),poly(hydroxyethyl acrylates), poly(hydroxyethyl-oxazolines),poly(hydroxymethacrylates), poly(hydroxypropylmethacrylamides),poly(hydroxypropyl methacrylates), poly(hydroxypropyloxazolines),poly(iminocarbonates), poly(lactic acids), poly(lactic-co-glycolicacids), poly(methacrylamides), poly(methacrylates),poly(methyloxazolines), poly(organophosphazenes), poly(ortho esters),poly(oxazolines), poly(propylene glycols), poly(siloxanes),poly(urethanes), poly(vinyl alcohols), poly(vinyl amines),poly(vinylmethylethers), poly(vinylpyrrolidones), silicones, celluloses,carbomethyl celluloses, hydroxypropyl methylcelluloses, chitins,chitosans, dextrans, dextrins, gelatins, hyaluronic acids andderivatives, functionalized hyaluronic acids, mannans, pectins,rhamnogalacturonans, starches, hydroxyalkyl starches, hydroxyethylstarches and other carbohydrate-based polymers, xylans, and copolymersthereof.

More preferably, —P^(a′), —P^(a″) and —P^(a′″) of formula (a)independently comprise a PEG-based moiety. Even more preferably,—P^(a′), —P^(a″) and —P^(a′″) of formula (a) independently comprise aPEG-based moiety comprising at least 20% PEG, even more preferably atleast 30%, even more preferably at least 40% PEG, even more preferablyat least 50% PEG, even more preferably at least 60% PEG, even morepreferably at least 70% PEG, even more preferably at least 80% PEG andmost preferably at least 90% PEG.

Preferably, —P^(a′), —P^(a″) and —P^(a′″) of formula (a) independentlyhave a molecular weight ranging from and including 5 kDa to 50 kDa, morepreferably have a molecular weight ranging from and including 5 kDa to40 kDa, even more preferably ranging from and including 7.5 kDa to 35kDa, even more preferably ranging from and 7.5 to 30 kDa, even morepreferably ranging from and including 10 to 30 kDa.

In one embodiment —P^(a′), —P^(a″) and —P^(a′″) of formula (a) have amolecular weight of about 5 kDa.

In another embodiment —P^(a′), —P^(a″) and —P^(a′″) of formula (a) havea molecular weight of about 7.5 kDa.

In another embodiment —P^(a′), —P^(a″) and —P^(a′″) of formula (a) havea molecular weight of about 10 kDa.

In another embodiment —P^(a′), —P^(a″) and —P^(a′″) of formula (a) havea molecular weight of about 12.5 kDa.

In another embodiment —P^(a′), —P^(a″) and —P^(a′″) of formula (a) havea molecular weight of about 15 kDa.

In another embodiment —P^(a′), —P^(a″) and —P^(a′″) of formula (a) havea molecular weight of about 20 kDa.

In one embodiment —Z comprises one moiety of formula (a).

In another embodiment —Z comprises two moieties of formula (a).

In another embodiment —Z comprises three moieties of formula (a).

Preferably, —Z is a moiety of formula (a).

More preferably, —Z comprises a moiety of formula (b)

-   -   wherein    -   the dashed line indicates attachment to -L²- or to the remainder        of —Z; and    -   m and p are independently of each other an integer ranging from        and including 150 to 1000; preferably an integer ranging from        and including 150 to 500; more preferably an integer ranging        from and including 200 to 500; and most preferably an integer        ranging from and including 400 to 500.

Preferably, m and p of formula (b) are the same integer.

Most preferably m and p of formula (b) are about 450.

Preferably, —Z is a moiety of formula (b).

The carrier —Z′ is a water-insoluble polymer, even more preferably ahydrogel. Preferably, such hydrogel comprises a polymer selected fromthe group consisting of 2-methacryloyl-oxyethyl phosphoyl cholins,poly(acrylic acids), poly(acrylates), poly(acrylamides), poly(alkyloxy)polymers, poly(amides), poly(amidoamines), poly(amino acids),poly(anhydrides), poly(aspartamides), poly(butyric acids), poly(glycolicacids), polybutylene terephthalates, poly(caprolactones),poly(carbonates), poly(cyanoacrylates), poly(dimethylacrylamides),poly(esters), poly(ethylenes), poly(ethyleneglycols), poly(ethyleneoxides), poly(ethyl phosphates), poly(ethyloxazolines), poly(glycolicacids), poly(hydroxyethyl acrylates), poly(hydroxyethyl-oxazolines),poly(hydroxymethacrylates), poly(hydroxypropylmethacrylamides),poly(hydroxypropyl methacrylates), poly(hydroxypropyloxazolines),poly(iminocarbonates), poly(lactic acids), poly(lactic-co-glycolicacids), poly(methacrylamides), poly(methacrylates),poly(methyloxazolines), poly(organophosphazenes), poly(ortho esters),poly(oxazolines), poly(propylene glycols), poly(siloxanes),poly(urethanes), poly(vinyl alcohols), poly(vinyl amines),poly(vinylmethylethers), poly(vinylpyrrolidones), silicones, celluloses,carbomethyl celluloses, hydroxypropyl methylcelluloses, chitins,chitosans, dextrans, dextrins, gelatins, hyaluronic acids andderivatives, functionalized hyaluronic acids, mannans, pectins,rhamnogalacturonans, starches, hydroxyalkyl starches, hydroxyethylstarches and other carbohydrate-based polymers, xylans, and copolymersthereof.

If the carrier —Z′ is a hydrogel, it is preferably a hydrogel comprisingPEG or hyaluronic acid. Most preferably such hydrogel comprises PEG.

Even more preferably, the carrier —Z′ is a hydrogel as described in WO2006/003014 A2, WO 2011/012715 A1 or WO 2014/056926 A1, which areherewith incorporated by reference in their entirety.

In another embodiment —Z′ is a polymer network formed through thephysical aggregation of polymer chains, which physical aggregation ispreferably caused by hydrogen bonds, crystallization, helix formation orcomplexation. In one embodiment such polymer network is a thermogellingpolymer.

If the controlled-release PTH compound of the present invention is aprodrug, its total mass is preferably at least 10 kDa, such as at least12 kDa, such as at least 15 kDa, such as at least 20 kDa or such as atleast 30 kDa. If the controlled-release PTH compound is a water-solubleprodrug, its total mass preferably is at most 250 kDa, such as at most200 kDa, 180 kDa, 150 kDa or 100 kDa. It is understood that nomeaningful upper molecular weight limit can be provided in case thecontrolled-release PTH compound is water-insoluble.

In a preferred embodiment the controlled-release PTH compound is offormula (IIe-i):

-   -   wherein    -   the unmarked dashed line indicates the attachment to a nitrogen        of -D which is a PTH moiety by forming an amide bond; and    -   the dashed line marked with the asterisk indicates attachment to        a moiety

-   -   wherein        -   m and p are independently an integer ranging from and            including 400 to 500.

Preferably, -D is attached to the PTH prodrug of formula (lie-i) throughthe N-terminal amine functional group of the PTH moiety.

In another preferred embodiment the PTH prodrug of the present inventionis of formula (IIf-i):

-   -   wherein    -   the unmarked dashed line indicates the attachment to a nitrogen        of -D which is a PTH moiety by forming an amide bond; and    -   the dashed line marked with the asterisk indicates attachment to        a moiety

-   -   wherein        -   m and p are independently an integer ranging from and            including 400 to 500.

Preferably, -D is attached to the PTH prodrug of formula (IIf-i) throughthe N-terminal amine functional group of the PTH moiety.

In a preferred embodiment the residual activity of thecontrolled-release PTH in the form of a PTH prodrug is less than 10%,more preferably less than 1%, even more preferably less than 0.1%, evenmore preferably less than 0.01%, even more preferably less than 0.001%and most preferably less than 0.0001%.

As used herein the term “residual activity” refers to the activityexhibited by the PTH prodrug with the PTH moiety bound to a carrier inrelation to the activity exhibited by the corresponding free PTH. Inthis context the term “activity” refers to binding to an activation ofthe PTH/PTHrP1 receptor resulting in activation of adenylate cyclase togenerate cAMP, phospholipase C to generate intracellular calcium, orosteoblastic expression of RANKL (which binds to RANK (ReceptorActivator of Nuclear Factor kB) on osteoclasts. It is understood thatmeasuring the residual activity of the PTH prodrug of the presentinvention takes time during which a certain amount of PTH will bereleased from the PTH prodrug of the present invention and that suchreleased PTH will distort the results measured for the PTH prodrug. Itis thus accepted practice to test the residual activity of a prodrugwith a conjugate in which the drug moiety, in this case PTH, isnon-reversibly, i.e. stably, bound to a carrier, which as closely aspossible resembles the structure of the PTH prodrug for which residualactivity is to be measured.

Preferably, the pharmaceutical composition comprising at least onecontrolled-release PTH compound of the present invention has a pHranging from and including pH 3 to pH 8. More preferably, thepharmaceutical composition has a pH ranging from and including pH 4 topH 6. Most preferably, the pharmaceutical composition has a pH rangingfrom and including pH 4 to pH 5.

In one embodiment the pharmaceutical composition comprising at least onecontrolled-release PTH compound of the present invention is a liquid orsuspension formulation. It is understood that the pharmaceuticalcomposition is a suspension formulation if the controlled-release PTHcompound of the present invention is water-insoluble.

In another embodiment the pharmaceutical composition comprising at leastone controlled-release PTH compound of the present invention is a dryformulation which is reconstituted before administration to a patient.

Such liquid, suspension, dry or reconstituted pharmaceutical compositioncomprises at least one excipient. Excipients used in parenteralformulations may be categorized as, for example, buffering agents,isotonicity modifiers, preservatives, stabilizers, anti-adsorptionagents, oxidation protection agents, viscosifiers/viscosity enhancingagents, or other auxiliary agents.

However, in some cases, one excipient may have dual or triple functions.Preferably, the at least one excipient comprised in the pharmaceuticalcomposition of the present invention is selected from the groupconsisting of

-   (i) Buffering agents: physiologically tolerated buffers to maintain    pH in a desired range, such as sodium phosphate, bicarbonate,    succinate, histidine, citrate and acetate, sulphate, nitrate,    chloride, pyruvate; antacids such as Mg(OH)₂ or ZnCO₃ may be also    used;-   (ii) Isotonicity modifiers: to minimize pain that can result from    cell damage due to osmotic pressure differences at the injection    depot; glycerin and sodium chloride are examples; effective    concentrations can be determined by osmometry using an assumed    osmolality of 285-315 mOsmol/kg for serum;-   (iii) Preservatives and/or antimicrobials: multidose parenteral    formulations require the addition of preservatives at a sufficient    concentration to minimize risk of patients becoming infected upon    injection and corresponding regulatory requirements have been    established; typical preservatives include m-cresol, phenol,    methylparaben, ethylparaben, propylparaben, butylparaben,    chlorobutanol, benzyl alcohol, phenylmercuric nitrate, thimerosol,    sorbic acid, potassium sorbate, benzoic acid, chlorocresol, and    benzalkonium chloride;-   (iv) Stabilizers: Stabilisation is achieved by strengthening of the    protein-stabilising forces, by destabilisation of the denatured    state, or by direct binding of excipients to the protein;    stabilizers may be amino acids such as alanine, arginine, aspartic    acid, glycine, histidine, lysine, proline, sugars such as glucose,    sucrose, trehalose, polyols such as glycerol, mannitol, sorbitol,    salts such as potassium phosphate, sodium sulphate, chelating agents    such as EDTA, hexaphosphate, ligands such as divalent metal ions    (zinc, calcium, etc.), other salts or organic molecules such as    phenolic derivatives; in addition, oligomers or polymers such as    cyclodextrins, dextran, dendrimers, PEG or PVP or protamine or HSA    may be used;-   (v) Anti-adsorption agents: Mainly ionic or non-ionic surfactants or    other proteins or soluble polymers are used to coat or adsorb    competitively to the inner surface of the formulation's container;    e.g., poloxamer (Pluronic F-68), PEG dodecyl ether (Brij 35),    polysorbate 20 and 80, dextran, polyethylene glycol,    PEG-polyhistidine, BSA and HSA and gelatins; chosen concentration    and type of excipient depends on the effect to be avoided but    typically a monolayer of surfactant is formed at the interface just    above the CMC value;-   (vi) Oxidation protection agents: antioxidants such as ascorbic    acid, ectoine, methionine, glutathione, monothioglycerol, morin,    polyethylenimine (PEI), propyl gallate, and vitamin E; chelating    agents such as citric acid, EDTA, hexaphosphate, and thioglycolic    acid may also be used;-   (vii) Viscosifiers or viscosity enhancers: in case of a suspension    retard settling of the particles in the vial and syringe and are    used in order to facilitate mixing and resuspension of the particles    and to make the suspension easier to inject (i.e., low force on the    syringe plunger); suitable viscosifiers or viscosity enhancers are,    for example, carbomer viscosifiers like Carbopol 940, Carbopol    Ultrez 10, cellulose derivatives like hydroxypropylmethylcellulose    (hypromellose, HPMC) or diethylaminoethyl cellulose (DEAE or    DEAE-C), colloidal magnesium silicate (Veegum) or sodium silicate,    hydroxyapatite gel, tricalcium phosphate gel, xanthans, carrageenans    like Satia gum UTC 30, aliphatic poly(hydroxy acids), such as    poly(D,L- or L-lactic acid) (PLA) and poly(glycolic acid) (PGA) and    their copolymers (PLGA), terpolymers of D,L-lactide, glycolide and    caprolactone, poloxamers, hydrophilic poly(oxyethylene) blocks and    hydrophobic poly(oxypropylene) blocks to make up a triblock of    poly(oxyethylene)-poly(oxypropylene)-poly(oxyethylene) (e.g.    Pluronic®), polyetherester copolymer, such as a polyethylene glycol    terephthalate/polybutylene terephthalate copolymer, sucrose acetate    isobutyrate (SAIB), dextran or derivatives thereof, combinations of    dextrans and PEG, polydimethylsiloxane, collagen, chitosan,    polyvinyl alcohol (PVA) and derivatives, polyalkylimides, poly    (acrylamide-co-diallyldimethyl ammonium (DADMA)),    polyvinylpyrrolidone (PVP), glycosaminoglycans (GAGs) such as    dermatan sulfate, chondroitin sulfate, keratan sulfate, heparin,    heparan sulfate, hyaluronan, ABA triblock or AB block copolymers    composed of hydrophobic A-blocks, such as polylactide (PLA) or    poly(lactide-co-glycolide) (PLGA), and hydrophilic B-blocks, such as    polyethylene glycol (PEG) or polyvinyl pyrrolidone; such block    copolymers as well as the abovementioned poloxamers may exhibit    reverse thermal gelation behavior (fluid state at room temperature    to facilitate administration and gel state above sol-gel transition    temperature at body temperature after injection);-   (viii) Spreading or diffusing agent: modifies the permeability of    connective tissue through the hydrolysis of components of the    extracellular matrix in the intrastitial space such as but not    limited to hyaluronic acid, a polysaccharide found in the    intercellular space of connective tissue; a spreading agent such as    but not limited to hyaluronidase temporarily decreases the viscosity    of the extracellular matrix and promotes diffusion of injected    drugs; and-   (ix) Other auxiliary agents: such as wetting agents, viscosity    modifiers, antibiotics, hyaluronidase; acids and bases such as    hydrochloric acid and sodium hydroxide are auxiliary agents    necessary for pH adjustment during manufacture.

In another aspect the present invention relates to a method of treating,controlling, delaying or preventing a condition which can be treated,controlled, delayed or prevented with PTH, the method comprising thestep of administering the controlled-release PTH compound in accordancewith a dosage regimen, in which dose adjustment in response tohypocalcemia or hypercalcemia is performed in increments of no more than25%.

Preferably, the pharmaceutical composition comprising acontrolled-release PTH compound is administered in accordance with adosage regimen in which dose adjustment in response to hypocalcemia orhypercalcemia is performed in increments of no more than 20%, morepreferably in increments of no more than 15% and most preferably inincrements of no more than 10%.

In on embodiment the pharmaceutical composition comprising acontrolled-release PTH compound is administered in accordance with adosage regimen in which dose adjustment in response to hypocalcemia orhypercalcemia is performed in increments of 25%.

More preferably, the pharmaceutical composition comprising acontrolled-release PTH compound is administered in accordance with adosage regimen in which dose adjustment in response to hypocalcemia orhypercalcemia is performed in increments of 20%.

Even more preferably, the pharmaceutical composition comprising acontrolled-release PTH compound is administered in accordance with adosage regimen in which dose adjustment in response to hypocalcemia orhypercalcemia is performed in increments of 15%.

Most preferably, the pharmaceutical composition comprising acontrolled-release PTH compound is administered in accordance with adosage regimen in which dose adjustment in response to hypocalcemia orhypercalcemia is performed in increments of 10%.

Preferably, the pharmaceutical comprising the controlled-release PTHcompound it administered to the patient at least every 24 hours, such asevery 24 hours, every 36 hours, every 48 hours, every 60 hours, every 72hours, every 84 hours, every 96 hours, every 108 hours, every 120 hours,every 132 hours, every 144 hours, every 156 hours, once a week, onceevery two weeks.

In one embodiment the pharmaceutical composition comprising thecontrolled-release PTH compound is administered every 24 hours.

In another embodiment the pharmaceutical composition comprising thecontrolled-release PTH compound is administered every 48 hours.

In another embodiment the pharmaceutical composition comprising thecontrolled-release PTH compound is administered every 72 hours.

In another embodiment the pharmaceutical composition comprising thecontrolled-release PTH compound is administered every 96 hours.

In another embodiment the pharmaceutical composition comprising thecontrolled-release PTH compound is administered every 120 hours.

In another embodiment the pharmaceutical composition comprising thecontrolled-release PTH compound is administered every 144 hours.

In another embodiment the pharmaceutical composition comprising thecontrolled-release PTH compound is administered once every week.

Preferably, the pharmaceutical composition comprising the PTH compoundis administered to a patient via subcutaneous administration, preferablyvia subcutaneous injection.

Preferred embodiments of the controlled-release PTH compound are asdescribed above.

Preferably, the condition that can be treated, controlled, delayed orprevented with PTH is selected from the group consisting ofhypoparathyroidism, hyperphosphatemia, osteoporosis, fracture repair,osteomalacia, osteomalacia and osteoporosis in patients withhypophosphatasia, steroid-induced osteoporosis, male osteoporosis,arthritis, osteoarthritis, osteogenesis imperfect, fibrous dysplasia,rheumatoid arthritis, Paget's disease, humoral hypercalcemia associatedwith malignancy, osteopenia, periodontal disease, bone fracture,alopecia, chemotherapy-induced alopecia, and thrombocytopenia. Morepreferably, the condition that can be treated, controlled, delayed orprevented with PTH is selected from the group consisting ofhypoparathyroidism, hyperphosphatemia, fracture repair, arthritis,osteoarthritis, rheumatoid arthritis, osteopenia, periodontal disease,bone fracture, alopecia, chemotherapy-induced alopecia, andthrombocytopenia.

Most preferably said condition is hypoparathyroidism.

Preferably, the patient undergoing the method of treatment of thepresent invention is a mammalian patient, preferably a human patient.

EXAMPLES

Materials and Methods

Side chain protected PTH(1-34) (SEQ ID NO:51) on TCP resin having Bocprotected N-terminus and ivDde protected side chain of Lys26(synthesized by Fmoc-strategy) was obtained from a custom peptidesynthesis supplier.

Side chain protected PTH(1-34) on TCP resin having Fmoc protectedN-terminus (synthesized by Fmoc-strategy) was obtained from a custompeptide synthesis supplier.

PEG 2×20 kDa maleimide, Sunbright GL2-400MA was purchased from NOFEurope N.V., Grobbendonk, Belgium. S-Trityl-6-mercaptohexanoic acid waspurchased from Polypeptide, Strasbourg, France. HATU was obtained fromMerck Biosciences GmbH, Schwalbach/Ts, Germany. Fmoc-N-Me-Asp(OBn)-OHwas obtained from Peptide International Inc., Louisville, Ky., USA.Fmoc-Aib-OH was purchased from Iris Biotech GmbH, Marktredwitz, Germany.All other chemicals and reagents were purchased from Sigma Aldrich GmbH,Taufkirchen, Germany, unless a different supplier is mentioned.

Compound 11a (examples 11-15) was synthesized following the proceduredescribed in patent WO29095479A2, example 1.

Syringes equipped with polyethylenene frits (MultiSynTech GmbH, Witten,Germany) were used as reaction vessels or for washing steps of peptideresins.

General procedure for the removal of ivDde protecting group from sidechain protected PTH on resin: The resin was pre-swollen in DMF for 30min and the solvent was discarded. The ivDde group was removed byincubating the resin with DMF/hydrazine hydrate 4/1 (v/v, 2.5 mL/gresin) for 8×15 min. For each step fresh DMF/hydrazine hydrate solutionwas used. Finally, the resin was washed with DMF (10 x), DCM (10 x) anddried in vacuo.

General procedure for the removal of Fmoc protecting group fromprotected PTH on resin: The resin was pre-swollen in DMF for 30 min andthe solvent was discarded. The Fmoc group was removed by incubating theresin with DMF/piperidine/DBU 96/2/2 (v/v/v, 2.5 mL/g resin) for 3×10min. For each step fresh DMF/piperidine/DBU solution was used. Finally,the resin was washed with DMF (10 x), DCM (10 x) and dried in vacuo.

RP-HPLC Purification:

For preparative RP-HPLC a Waters 600 controller and a 2487 DualAbsorbance Detector was used, equipped with the following columns:Waters XBridge™ BEH300 Prep C18 5 μm, 150×10 mm, flow rate 6 mL/min, orWaters XBridge™ BEH300 Prep C18 10 μm, 150×30 mm, flow rate 40 mL/min.Linear gradients of solvent system A (water containing 0.1% TFA v/v) andsolvent system B (acetonitrile containing 0.1% TFA v/v) were used. HPLCfractions containing product were pooled and lyophilized if not statedotherwise.

Flash Chromatography:

Flash chromatography purifications were performed on an Isolera Onesystem from Biotage AB, Sweden, using Biotage KP-Sil silica cartridgesand n-heptane and ethyl acetate as eluents. Products were detected at254 nm.

Ion Exchange Chromatography:

Ion exchange chromatography (IEX) was performed using an AmershamBioscience AEKTAbasic system equipped with a MacroCap SP cationexchanger column (Amersham Bioscience/GE Healthcare). 17 mM acetic acidpH 4.5 (solvent A) and 17 mM acetic acid, 1 M NaCl, pH 4.5 (solvent B)were used as mobile phases.

Size Exclusion Chromatography:

Size exclusion chromatography (SEC) was performed using an AmershamBioscience AEKTAbasic system equipped with HiPrep 26/10 desaltingcolumns (Amersham Bioscience/GE Healthcare). 0.1% (v/v) acetic acid wasused as mobile phase.

Analytical Methods

Analytical ultra-performance LC (UPLC)-MS was performed on a WatersAcquity system equipped with a Waters BEH300 C18 column (2.1×50 mm, 1.7μm particle size, flow: 0.25 mL/min; solvent A: water containing 0.04%TFA (v/v), solvent B: acetonitrile containing 0.05% TFA (v/v)) coupledto a LTQ Orbitrap Discovery mass spectrometer from Thermo Scientific orcoupled to a Waters Micromass ZQ.

Example 1

Synthesis of Linker Reagent 1f

Linker reagent 1f was synthesized according to the following scheme:

To a solution of N-methyl-N-Boc-ethylenediamine (2 g, 11.48 mmol) andNaCNBH₃ (819 mg, 12.63 mmol) in MeOH (20 mL) was added2,4,6-trimethoxybenzaldehyde (2.08 g, 10.61 mmol) portion wise. Themixture was stirred at rt for 90 min, acidified with 3 M HCl (4 mL) andstirred further 15 min. The reaction mixture was added to saturatedNaHCO₃ solution (200 mL) and extracted 5× with DCM. The combined organicphases were dried over Na₂SO₄ and the solvents were evaporated in vacuo.The resulting N-methyl-N-Boc-N′-Tmob-ethylenediamine 1a was dried inhigh vacuum and used in the next reaction step without furtherpurification.

Yield: 3.76 g (11.48 mmol, 89% purity, 1a: double Tmob protectedproduct=8:1)

MS: m/z 355.22=[M+H]⁺, (calculated monoisotopic mass=354.21).

To a solution of 1a (2 g, 5.65 mmol) in DCM (24 mL) COMU (4.84 g, 11.3mmol), N-Fmoc-N-Me-Asp(OBn)-OH (2.08 g, 4.52 mmol) and 2,4,6-collidine(2.65 mL, 20.34 mmol) were added. The reaction mixture was stirred for 3h at rt, diluted with DCM (250 mL) and washed 3× with 0.1 M H₂SO₄ (100mL) and 3× with brine (100 mL). The aqueous phases were re-extractedwith DCM (100 mL). The combined organic phases were dried over Na₂SO₄,filtrated and the residue concentrated to a volume of 24 mL. 1b waspurified using flash chromatography.

Yield: 5.31 g (148%, 6.66 mmol)

MS: m/z 796.38=[M+H]⁺, (calculated monoisotopic mass=795.37).

To a solution of 1b (5.31 g, max. 4.52 mmol ref. toN-Fmoc-N-Me-Asp(OBn)-OH) in THF (60 mL) DBU (1.8 mL, 3% v/v) was added.The solution was stirred for 12 min at rt, diluted with DCM (400 mL) andwashed 3× with 0.1 M H₂SO₄ (150 mL) and 3× with brine (150 mL). Theaqueous phases were re-extracted with DCM (100 mL). The combined organicphases were dried over Na₂SO₄ and filtrated. 1c was isolated uponevaporation of the solvent and used in the next reaction without furtherpurification.

MS: m/z 574.31=[M+H]⁺, (calculated monoisotopic mass=573.30).

1c (5.31 g, 4.52 mmol, crude) was dissolved in acetonitrile (26 mL) andCOMU (3.87 g, 9.04 mmol), 6-tritylmercaptohexanoic acid (2.12 g, 5.42mmol) and 2,4,6-collidine (2.35 mL, 18.08 mmol) were added. The reactionmixture was stirred for 4 h at rt, diluted with DCM (400 mL) and washed3× with 0.1 M H₂SO₄ (100 mL) and 3× with brine (100 mL). The aqueousphases were re-extracted with DCM (100 mL). The combined organic phaseswere dried over Na₂SO₄, filtered and 1d was isolated upon evaporation ofthe solvent. Product 1d was purified using flash chromatography.

Yield: 2.63 g (62%, 94% purity)

MS: m/z 856.41=[M+H]⁺, (calculated monoisotopic mass=855.41).

To a solution of 1d (2.63 g, 2.78 mmol) in i-PrOH (33 mL) and H₂O (11mL) was added LiOH (267 mg, 11.12 mmol) and the reaction mixture wasstirred for 70 min at rt. The mixture was diluted with DCM (200 mL) andwashed 3× with 0.1 M H₂SO₄ (50 mL) and 3× with brine (50 mL). Theaqueous phases were re-extracted with DCM (100 mL). The combined organicphases were dried over Na₂SO₄, filtered and 1e was isolated uponevaporation of the solvent. 1e was purified using flash chromatography.

Yield: 2.1 g (88%)

MS: m/z 878.4=[M+Na]⁺, (calculated monoisotopic mass=837.40).

To a solution of 1e (170 mg, 0.198 mmol) in anhydrous DCM (4 mL) wereadded DCC (123 mg, 0.59 mmol), and a catalytic amount of DMAP. After 5min, N-hydroxy-succinimide (114 mg, 0.99 mmol) was added and thereaction mixture was stirred at rt for 1 h. The reaction mixture wasfiltered, the solvent was removed in vacuo and the residue was taken upin 90% acetonitrile plus 0.1% TFA (3.4 mL). The crude mixture waspurified by RP-HPLC. Product fractions were neutralized with 0.5 M pH7.4 phosphate buffer and concentrated. The remaining aqueous phase wasextracted with DCM and 1f was isolated upon evaporation of the solvent.

Yield: 154 mg (81%)

MS: m/z 953.4=[M+H]⁺, (calculated monoisotopic mass=952.43)

Example 2

Synthesis of Linker Reagent 2g

4-Methoxytriphenylmethyl chloride (3.00 g, 9.71 mmol) was dissolved inDCM (20 mL) and added dropwise under stirring to a solution ofethylenediamine 2a (6.5 mL, 97.3 mmol) in DCM (20 mL). The reactionmixture was stirred for 2 h at rt after which it was diluted withdiethyl ether (300 mL), washed 3× with brine/0.1 M NaOH 30/1 (v/v) andonce with brine. The organic phase was dried over Na₂SO₄ and 2b wasisolated upon evaporation of the solvent.

Yield: 3.18 g (98%)

Mmt protected intermediate 2b (3.18 g, 9.56 mmol) was dissolved in DCM(30 mL). 6-(Tritylthio)-hexanoic acid (4.48 g, 11.5 mmol), PyBOP (5.67g, 10.9 mmol) and DIPEA (5.0 mL, 28.6 mmol) were added and the mixturewas stirred for 30 min at rt. The solution was diluted with diethylether (250 mL), washed 3× with brine/0.1 M NaOH 30/1 (v/v) and once withbrine. The organic phase was dried over Na₂SO₄ and the solvent wasremoved in vacuo. 2c was purified using flash chromatography.

Yield: 5.69 g (85%)

MS: m/z 705.4=[M+H]⁺, (calculated monoisotopic mass=704.34).

Compound 2c (3.19 g, 4.53 mmol) was dissolved in abhydrous THF (50 mL),1 M BH₃.THF solution in THF (8.5 mL, 8.5 mmol) was added and the mixturewas stirred for 16 h at rt. More 1 M BH₃.THF solution in THF (14 mL,14.0 mmol) was added and the mixture was stirred for further 16 h at rt.Methanol (8.5 mL) and N,N′-dimethyl-ethylendiamine (3.00 mL, 27.9 mmol)were added and the mixture was heated under reflux for 3 h. The mixturewas allowed to cool down and ethyl acetate (300 mL) was added. Thesolution was washed 2× with aqueous Na₂CO₃ and 2× with aqueous NaHCO₃.The organic phase was dried over Na₂SO₄ and the solvent was removed invacuo to obtain 2d.

Yield: 3.22 g (103%)

MS: m/z 691.4=[M+H]⁺, (calculated monoisotopic mass=690.36).

Di-tert-butyl dicarbonate (2.32 g, 10.6 mmol) and DIPEA (3.09 mL, 17.7mmol) were dissolved in DCM (5 mL) and added to a solution of 2d (2.45g, 3.55 mmol) in DCM (5 mL). The mixture was stirred for 30 min at rt.The solution was concentrated in vacuo and purified by flashchromatography to obtain product 2e.

Yield: 2.09 g (74%)

MS: m/z 791.4=[M+H]⁺, (calculated monoisotopic mass=790.42).

Compound 2e (5.01 g, 6.34 mmol) was dissolved in acetonitrile (80 mL).0.4 M aqueous HCl (80 mL) followed by acetonitrile (20 mL) was added andthe mixture was stirred for 1 h at rt. The pH was adjusted to pH 5.5 byaddition of aqueous 5 M NaOH. The organic solvent was removed in vacuoand the remaining aqueous solution was extracted 4× with DCM. Thecombined organic phases were dried over Na₂SO₄ and the solvent wasremoved in vacuo to obtain product 2f.

Yield: 4.77 g (95%)

MS: m/z 519.3=[M+H]⁺, (calculated monoisotopic mass=518.30).

Compound 2f (5.27 g, 6.65 mmol) was dissolved in DCM (30 mL) and addedto a solution of p-nitrophenyl chloroformate (2.01 g, 9.98 mmol) in DCM(25 mL). 2,4,6-trimethylpyridine (4.38 mL, 33.3 mmol) was added and thesolution was stirred for 45 min at rt. The solution was concentrated invacuo and purified by flash chromatography to obtain product 2g.

Yield: 4.04 g (89%)

MS: m/z 706.32=[M+Na]⁺, (calculated monoisotopic mass=683.30).

Example 3

Synthesis of Permanent S1 PTH(1-34) Conjugate 3

Side chain protected PTH(1-34) on TCP resin having Fmoc protectedN-terminus was Fmoc deprotected according to the procedure given inMaterials and Methods. A solution of 6-tritylmercaptohexanoic acid (62.5mg, 160 μmol), PyBOP (80.1 mg, 154 μmol) and DIPEA (53 μL, 306 μmol) inDMF (2 mL) was added to 0.21 g (51 μmol) of the resin. The suspensionwas agitated for 80 min at rt. The resin was washed 10× with DMF, 10×with DCM and dried in vacuo. Cleavage of the peptide from the resin andremoval of protecting groups was achieved by adding 10 mL cleavagecocktail 100/3/3/2/1 (v/w/v/v/v) TFA/DTT/TES/water/thioanisole andagitating the suspension for 1 h at rt. Crude 3 was precipitated inpre-cooled diethyl ether (−18° C.). The precipitate was dissolved inACN/water and purified by RP-HPLC. The product fractions werefreeze-dried.

Yield: 36 mg (14%), 3*8 TFA

MS: m/z 1062.31=[M+4H]⁴⁺, (calculated monoisotopic mass for[M+4H]⁴⁺=1062.30).

Example 4

Synthesis of Permanent K26 PTH(1-34) Conjugate 4

Side chain protected PTH(1-34) on TCP resin having Boc protectedN-terminus and ivDde protected side chain of Lys26 was ivDde deprotectedaccording to the procedure given in Materials and Methods. A solution of6-tritylmercaptohexanoic acid (107 mg, 273 μmol), PyBOP (141 mg, 273μmol) and DIPEA (95 μL, 545 μmol) in DMF (3 mL) was added to 0.80 g(90.9 μmol) of the resin. The suspension was agitated for 1 h at rt. Theresin was washed 10× with DMF, 10× with DCM and dried in vacuo. Cleavageof the peptide from the resin and removal of protecting groups wasachieved by adding 6 mL cleavage cocktail 100/3/3/2/1 (v/w/v/v/v)TFA/DTT/TES/water/thioanisole and agitating the suspension for 1 h atrt. Crude 4 was precipitated in pre-cooled diethyl ether (−18° C.). Theprecipitate was dissolved in ACN/water and purified by RP-HPLC. Theproduct fractions were freeze-dried.

Yield: 40 mg (8%), 4*8 TFA

MS: m/z 1062.30=[M+4H]⁴⁺, (calculated monoisotopic mass for[M+4H]⁴⁺=1062.30).

Example 5

Synthesis of Transient S1 PTH(1-34) Conjugate

Side chain protected PTH(1-34) on TCP resin having Fmoc protectedN-terminus was Fmoc deprotected according to the procedure given inMaterials and Methods. A solution of Fmoc-Aib-OH (79 mg, 244 μmol),PyBOP (127 mg, 244 μmol) and DIPEA (64 μL, 365 μmol) in DMF (1.5 mL) wasadded to 0.60 g (61 μmol) of the resin. The suspension was agitated for16 h at rt. The resin was washed 10× with DMF and Fmoc-deprotected asdescribed above. A solution of 2g (167 mg, 244 μmol) and DIPEA (64 μL,365 μmol) in DMF (1.5 mL) was added to the resin. The suspension wasagitated for 24 h at rt. The resin was washed 10× with DMF, 10× with DCMand dried in vacuo. Cleavage of the peptide from the resin and removalof protecting groups was achieved by adding 7 mL cleavage cocktail100/3/3/2/1 (v/w/v/v/v) TFA/DTT/TES/water/thioanisole and agitating thesuspension for 1 h at rt. Crude 5 was precipitated in pre-cooled diethylether (−18° C.). The precipitate was dissolved in ACN/water and purifiedby RP-HPLC. The product fractions were freeze-dried.

Yield: 78 mg (24%), 5*9 TFA

MS: m/z 1101.59=[M+4H]⁴⁺, (calculated monoisotopic mass for[M+4H]⁴⁺=1101.57).

Example 6

Synthesis of Transient S1 PTH(1-34) Conjugate 6

Side chain protected PTH(1-34) on TCP resin having Fmoc protectedN-terminus was Fmoc deprotected according to the procedure given inMaterials and Methods. A solution of Fmoc-Ala-OH (32 mg, 102 μmol),PyBOP (53 mg, 102 μmol) and DIPEA (27 μL, 152 μmol) in DMF (3 mL) wasadded to 0.25 g (25 μmol) of the resin. The suspension was shaken for 1h at rt. The resin was washed 10× with DMF, 10× with DCM and dried undervacuum. Fmoc-deprotection was performed as described above. A solutionof 2g (69 mg, 102 μmol) and DIPEA (27 μL, 152 μmol) in DMF (3 mL) wasadded to the resin. The suspension was agitated for 1.5 h at rt. Theresin was washed 10× with DMF, 10× with DCM and dried in vacuo. Cleavageof the peptide from the resin and removal of protecting groups wasachieved by adding 3 mL cleavage cocktail 100/3/3/2/1 (v/w/v/v/v)TFA/DTT/TES/water/thioanisole and agitating the suspension for 1 h atrt. Crude 6 was precipitated in pre-cooled diethyl ether (−18° C.). Theprecipitate was dissolved in ACN/water and purified by RP-HPLC. Theproduct fractions were freeze-dried.

Yield: 25 mg (18%), 6*9 TFA

MS: m/z 1098.75=[M+4H]⁴⁺, (calculated monoisotopic mass for[M+4H]⁴⁺=1098.07).

Example 7

Synthesis of Transient S1 PTH(1-34) Conjugate 7

Side chain protected PTH(1-34) on TCP resin having Fmoc protectedN-terminus was Fmoc deprotected according to the procedure given inMaterials and Methods. A solution of Fmoc-Ser(Trt)-OH (117 mg, 205μmol), PyBOP (108 mg, 207 μmol) and DIPEA (53 μL, 305 μmol) in DMF (2mL) was added to 0.50 g (51 μmol) of the resin. The suspension wasagitated for 1 h at rt. The resin was washed 10× with DMF, 10× with DCMand dried under vacuum. Fmoc-deprotection was performed as describedabove. A solution of 2g (144 mg, 211 μmol) and DIPEA (53 μL, 305 μmol)in DMF (1.8 mL) was added to the resin. The suspension was shaken for 7h at rt. The resin was washed 10× with DMF, 10× with DCM and dried invacuo. Cleavage of the peptide from the resin and removal of protectinggroups was achieved by adding 6 mL cleavage cocktail 100/3/3/2/1(v/w/v/v/v) TFA/DTT/TES/water/thioanisole and agitating the suspensionfor 1 h at rt. Crude 7 was precipitated in pre-cooled diethyl ether(−18° C.). The precipitate was dissolved in ACN/water and purified byRP-HPLC. The product fractions were freeze-dried.

Yield: 54 mg (20%), 7*9 TFA

MS: m/z 1102.08=[M+4H]⁴⁺, (calculated monoisotopic mass for[M+4H]⁴⁺=1102.07).

Example 8

Synthesis of Transient S1 PTH(1-34) Conjugate 8

Side chain protected PTH(1-34) on TCP resin having Fmoc protectedN-terminus was Fmoc deprotected according to the procedure given inMaterials and Methods. A solution of Fmoc-Leu-OH (36 mg, 102 μmol),PyBOP (53 mg, 102 μmol) and DIPEA (27 μL, 152 μmol) in DMF (3 mL) wasadded to 0.25 g (25 μmol) of the resin. The suspension was agitated for1 h at rt. The resin was washed 10× with DMF, 10× with DCM and driedunder vacuum. Fmoc-deprotection was performed as described above. Asolution of 2g (69 mg, 102 μmol) and DIPEA (27 μL, 152 μmol) in DMF (3mL) was added to the resin. The suspension was agitated for 1.5 h at rt.The resin was washed 10× with DMF, 10× with DCM and dried in vacuo.Cleavage of the peptide from the resin and removal of protecting groupswas achieved by adding 3 mL cleavage cocktail 100/3/3/2/1 (v/w/v/v/v)TFA/DTT/TES/water/thioanisole and agitating the suspension for 1 h atrt. Crude 8 was precipitated in pre-cooled diethyl ether (−18° C.). Theprecipitate was dissolved in ACN/water and purified by RP-HPLC. Theproduct fractions were freeze-dried.

Yield: 31 mg (22%), 8*9 TFA

MS: m/z 1109.32=[M+4H]⁴⁺, (calculated monoisotopic mass for[M+4H]⁴⁺=1108.58).

Example 9

Synthesis of Transient S1 PTH(1-34) Conjugate 9

Side chain protected PTH(1-34) on TCP resin having Fmoc protectedN-terminus was Fmoc deprotected according to the procedure given inMaterials and Methods. A solution of 1e (182 mg, 213 μmol), PyBOP (111mg, 213 μmol) and DIPEA (93 μL, 532 μmol) in DMF (5 mL) was added to2.00 g (107 μmol) of the resin. The suspension was agitated for 16 h atrt. The resin was washed 10× with DMF, 10× with DCM and dried undervacuum. Cleavage of the peptide from the resin and removal of protectinggroups was achieved by adding 20 mL cleavage cocktail 100/3/3/2/1(v/w/v/v/v) TFA/DTT/TES/water/thioanisole and agitating the suspensionfor 1 h at rt. Crude 9 was precipitated in pre-cooled diethyl ether(−18° C.). The precipitate was dissolved in ACN/water and purified byRP-HPLC. The product fractions were freeze-dried.

Yield: 47 mg (8%), 9*9 TFA

MS: m/z 1108.58=[M+4H]⁴⁺, (calculated monoisotopic mass for[M+4H]⁴+=1108.57).

Example 10

Synthesis of Transient K26 PTH(1-34) Conjugate 10

Side chain protected PTH(1-34) on TCP resin having Boc protectedN-terminus and ivDde protected side chain of Lys26 was ivDde deprotectedaccording to the procedure given in Materials and Methods. A solution of1f (867 mg, 910 μmol) and DIPEA (0.24 mL, 1.36 mmol) in DMF (5 mL) wasadded to 1.91 g (227 μmol) of the resin. The suspension was agitated for1 h at rt. The resin was washed 10× with DMF, 10× with DCM and driedunder vacuum. Cleavage of the peptide from the resin and removal ofprotecting groups was achieved by adding 20 μmL cleavage cocktail100/3/3/2/1 (v/w/v/v/v) TFA/DTT/TES/water/thioanisole and shaking thesuspension for 1 h at rt. Crude 10 was precipitated in pre-cooleddiethyl ether (−18° C.). The precipitate was dissolved in ACN/water andpurified by RP-HPLC. The product fractions were freeze-dried.

Yield: 92 mg (7%), 10*9 TFA

MS: m/z 1108.58=[M+4H]⁴⁺, (calculated monoisotopic mass for[M+4H]⁴+=1108.57).

Example 11

Synthesis of Low Molecular Weight Transient S1 PEG Conjugate 11b

0.15 mL of a 0.5 M NaH₂PO₄ buffer (pH 7.4) was added to 0.5 mL of a 20mg/mL solution of thiol 5 (10 mg, 1.84 μmol) in 1/1 (v/v)acetonitrile/water containing 0.1% TFA (v/v). The solution was incubatedat rt for 10 min after which 238 μL of a 10 mg/mL solution of maleimide11a (2.4 mg, 2.21 μmol) in 1/1 (v/v) acetonitrile/water containing 0.1%TFA (v/v) were added. The solution was incubated for 20 min at rt. 10 μLTFA was added and the mixture was purified by RP-HPLC. The productfractions were freeze-dried to obtain 11b.

Yield: 3.1 mg (26%), 11b*9 TFA

MS: m/z 1097.00=[M+4H]⁴⁺, (calculated monoisotopic mass for[M+5H]⁵+=1096.99).

Example 12

Synthesis of Low Molecular Weight Transient S1 PEG Conjugate 12

Conjugate 12 was synthesized as described for 11b by using thiol 6 (10mg, 1.85 μmol) and maleimide 11a (2.4 mg, 2.21 μmol).

Yield: 10 mg (83%), 12*9 TFA

MS: m/z 1094.20=[M+4H]⁴⁺, (calculated monoisotopic mass for[M+4H]⁴+=1094.19).

Example 13

Synthesis of Low Molecular Weight Transient S1 PEG Conjugate 13

Conjugate 13 was synthesized as described for 11b by using thiol 7 (10mg, 1.84 μmol) and maleimide 11a (2.4 mg, 2.21 μmol).

Yield: 8 mg (67%), 13*9 TFA

MS: m/z 1097.40=[M+5H]⁵⁺, (calculated monoisotopic mass for[M+5H]⁵⁺=1097.39).

Example 14

Synthesis of Low Molecular Weight Transient S1 PEG Conjugate 14

Conjugate 14 was synthesized as described for 11b by using thiol 8 (10mg, 1.83 μmol) and maleimide 11a (2.4 mg, 2.21 μmol).

Yield: 4 mg (33%), 14*9 TFA

MS: m/z 1378.01=[M+4H]⁴⁺, (calculated monoisotopic mass for[M+4H]⁴+=1378.00).

Example 15

Synthesis of Low Molecular Weight Transient K26 PEG Conjugate 15

Conjugate 15 was synthesized as described for 11b by using thiol 10 (5.2mg, 0.95 μmol) and maleimide 11a (1.23 mg, 1.14 μmol).

Yield: 2.1 mg (33%), 15*9 TFA

MS: m/z 1102.60=[M+5H]⁵⁺, (calculated monoisotopic mass for[M+5H]⁵+=1102.59).

Example 16

Synthesis of Permanent 2×20 kDa S1 PEG Conjugate 16

772 μL of a solution containing thiol 3 (19.4 mg/mL, 15 mg, 3.54 μmol)and 2.5 mg/mL Boc-L-Met in 1/1 (v/v) acetonitrile/water containing 0.1%TFA (v/v) were added to 1.87 mL of a solution containing PEG 2×20 kDamaleimide (Sunbright GL2-400MA, 187 mg, 4.32 μmol) and 2.5 mg/mLBoc-L-Met in water containing 0.1% TFA (v/v). 0.5 M NaH₂PO₄ buffer (0.66mL, pH 7.0) was added and the mixture was stirred for 30 min at rt. 10μL of a 270 mg/mL solution of 2-mercaptoethanol in water was added. Themixture was stirred for 5 min at rt and 0.33 mL 1 M HCl were added.Conjugate 16 was purified by IEX followed by RP-HPLC using a lineargradient of solvent system A (water containing 0.1% AcOH v/v) andsolvent system B (acetonitrile containing 0.1% AcOH v/v). The productcontaining fractions were freeze-dried.

Yield: 97 mg (2.01 μmol, 57%) conjugate 16*8 AcOH

Example 17

Synthesis of Permanent 2×20 kDa K26 PEG Conjugate 17

Conjugate 17 was prepared as described for 16 by reaction of thiol 4 (15mg, 3.53 μmol) and PEG 2×20 kDa maleimide (Sunbright GL2-400MA, 187 mg,4.32 μmol).

Yield: 80 mg (1.79 μmol, 51%) conjugate 17*8 AcOH

Example 18

Synthesis of Transient 2×20 kDa S1 PEG Conjugate 18

Conjugate 18 was prepared as described for 16 by reaction of thiol 5 (37mg, 8.40 μmol) and PEG 2×20 kDa maleimide (Sunbright GL2-400MA, 445 mg,9.24 μmol). The reaction was quenched by addition of 50 μL TFA withoutprior addition of 2-mercaptoethanol. Conjugate 18 was purified by IEXfollowed by SEC for desalting. The product containing fractions werefreeze-dried.

Yield: 161 mg (3.33 μmol, 40%) conjugate 18*9 AcOH

Example 19

Synthesis of Transient 2×20 kDa S1 PEG Conjugate 19

Conjugate 19 was prepared as described for 16 by reaction of thiol 7 (27mg, 6.14 μmol) and PEG 2×20 kDa maleimide (Sunbright GL2-400MA, 325 mg,7.50 μmol).

Yield: 249 mg (5.16 μmol, 84%) conjugate 19*9 AcOH

Example 20

Synthesis of Transient 2×20 kDa S1 PEG Conjugate 20

Conjugate 20 was prepared as described for 16 by reaction of thiol 9 (38mg, 8.59 μmol) and PEG 2×20 kDa maleimide (Sunbright GL2-400MA, 455 mg,9.45 μmol). The reaction was quenched by addition of 50 μL TFA withoutprior addition of 2-mercaptoethanol. Conjugate 20 was purified by IEXfollowed by SEC for desalting. The product containing fractions werefreeze-dried.

Yield: 194 mg (4.01 μmol, 47%) conjugate 20*9 AcOH

Example 21

Synthesis of Transient 2×20 kDa K26 PEG Conjugate 21

Conjugate 21 was prepared as described for 16 by reaction of thiol 10(34 mg, 7.58 μmol) and PEG 2×20 kDa maleimide (Sunbright GL2-400MA, 401mg, 9.26 μmol).

Yield: 256 mg (5.30 μmol, 70%) conjugate 21*9 AcOH

Example 22

Dose Range Finding Study—Dose Adjustment Study in Cynomolgus Monkeyswith Daily Subcutaneous Injections with TransCon PTH

Method:

This study was conducted in order to test the hypothesis of performingdose adjustments with TransCon PTH in 25% increments in response tohypocalcemia or hypercalcemia. The study was performed in male andfemale Cynomolgus monkeys. Four groups with one male and one femaleanimal in each were dosed for four weeks starting at doses 0.2, 0.5, 1.0and 2.0 μg/kg/day, respectively. Serum calcium (sCa) levels in theanimals were measured pre-dose and post-dose on days -6, 1, 3, 7, 8, 12,14, 16, 19, 23, 26, 28 and 29.

Results:

Daily subcutaneous administration of TransCon PTH at doses of 0.2, 0.5and 1.0 jag/kg/day for 28 days was well tolerated and was associatedwith expected sporadic slight increases in sCa levels (from 1.05× up to1.12× compared to pre-study levels). On Day 3 for the male and femaledosed at 2.0 μg/kg/day day sCa rose to severe hypercalcaemic levels (upto 1.42× and 1.34×, respectively, compared to pre-study levels). Dosingwas discontinued in these two animals followed by a dosing holiday. OnDay 23 dosing was resumed at 1.5 g/kg/day (25% dose reduction) for oneweek. On Day 23 (first day of dosing after the dosing holiday),increases in calcium were noted at all timepoints for the male (from1.05× to 1.12× to pre-study levels) with peak concentration achieved 4hrs postdose. On Day 26, the increases were noted for male and female(up to 1.17× to pre-study levels). On Day 29, calcium increases werestill present in both sexes.

CONCLUSION

A dose of a controlled-release PTH compound administered subcutaneouslyto male and female cynomolgus monkeys was successfully adjusted(reduced) at a 25% increment as a response to hypercalcemia. The levelof sCa was lower in the animals after dosing with the 25% reduced dosecompared to dosing with the original higher dose.

Abbreviations:

-   ACN acetonitrile-   AcOH acetic acid-   Aib 2-aminoisobutyric acid-   BMD bone mineral density-   Bn benzyl-   Boc tert-butyloxycarbonyl-   COMU    (1-cyano-2-ethoxy-2-oxoethylidenaminooxy)dimethylamino-morpholino-carbenium    hexafluorophosphate-   cAMP cyclic adenosine monophosphate-   d day-   DBU 1,3-diazabicyclo[5.4.0]undecene-   DCC N,N′-dicyclohexylcarbodiimide-   DCM dichloromethane-   DIPEA N,N-diisopropylethylamine-   DMAP dimethylamino-pyridine-   DMF N,N-dimethylformamide-   DMSO dimethylsulfoxide-   DTT dithiothreitol-   EDTA ethylenediaminetetraacetic acid-   eq stoichiometric equivalent-   ESI-MS electrospray ionization mass spectrometry-   Et ethyl-   Fmoc 9-fluorenylmethyloxycarbonyl-   Glu-C endoproteinase Glu-C-   h hour-   HATU O-(7-azabenzotriazole- 1-yl)-N,N,N′,N′-tetramethyluronium    hexafluorophosphate-   HP hypoparathyroidism-   HPLC high performance liquid chromatography-   ivDde 4,4-dimethyl-2,6-dioxocyclohex-1-ylidene)-3-methylbutyl-   LC liquid chromatography-   LTQ linear trap quadrupole-   Lys-C endoproteinase Lys-C-   LLOQ lower limit of quantification-   Mal 3-maleimido propyl-   Me methyl-   MeOH methanol-   min minutes-   Mmt monomethoxytrityl-   MS mass spectrum/mass spectrometry-   m/z mass-to-charge ratio-   OtBu tert-butyloxy-   PEG poly(ethylene glycol)-   pH potentia Hydrogenii-   PK pharmacokinetics-   Pr propyl-   PTH parathyroid hormone-   PyBOP benzotriazol- 1-yl-oxytripyrrolidinophosphonium    hexafluorophosphate-   Q-TOF quadrupole time-of-flight-   RP-HPLC reversed-phase high performance liquid chromatography-   rt room temperature-   sCa serum calcium-   SIM single ion monitoring-   SEC size exclusion chromatography-   sc subcutaneous-   sP serum phosphate-   t_(1/2) half life-   TCP tritylchloride polystyrol-   TES triethylsilane-   TFA trifluoroacetic acid-   THF tetrahydrofuran-   Tmob 2,4,6-trimethoxybenzyl-   TPTx thyroparathyroidectomy-   Trt triphenylmethyl, trityl-   ULOQ upper limit of quantification-   UPLC ultra performance liquid chromatography-   UV ultraviolet-   ZQ single quadrupole

1. A pharmaceutical composition comprising a controlled-release PTHcompound or a pharmaceutically acceptable salt, hydrate, or solvatethereof, for use in a method of treating, controlling, delaying orpreventing a condition which can be treated, controlled, delayed orprevented with PTH, wherein the pharmaceutical composition comprisingthe controlled-release PTH compound is administered in accordance with adosage regimen in which dose adjustment in response to hypocalcemia orhypercalcemia is performed in increments of no more than 25%.
 2. Thepharmaceutical composition of claim 1, wherein the controlled-releasePTH compound is administered in accordance with a dosage regimen inwhich dose adjustment in response to hypocalcemia or hypercalcemia isperformed in increments of no more than 20%.
 3. The pharmaceuticalcomposition of claim 1 or 2, wherein the controlled-release PTH compoundis administered in accordance with a dosage regimen in which doseadjustment in response to hypocalcemia or hypercalcemia is performed inincrements of no more than 15%.
 4. The pharmaceutical composition of anyone of claims 1 to 3, wherein the controlled-release PTH compound isadministered in accordance with a dosage regimen in which doseadjustment in response to hypocalcemia or hypercalcemia is performed inincrements of no more than 10%.
 5. The pharmaceutical composition of anyone of claims 1 to 4, wherein the controlled-release PTH compound isadministered in accordance with a dosage regimen in which doseadjustment in response to hypocalcemia or hypercalcemia is performed inincrements of 10%.
 6. The pharmaceutical composition of any one ofclaims 1 to 5, wherein the pharmaceutical composition comprising thecontrolled-release PTH compound is administered to the patient no morefrequent than once every 24 hours.
 7. The pharmaceutical composition ofany one of claims 1 to 6, wherein the pharmaceutical composition isadministered to the patient once every 24 hours.
 8. The pharmaceuticalcomposition of any one of claims 1 to 7, wherein the pharmaceuticalcomposition comprising the PTH compound is administered to a patient viasubcutaneous administration.
 9. The pharmaceutical composition of anyone of claims 1 to 8, wherein the controlled-release PTH compoundcomprises a PTH molecule or moiety having the sequence of SEQ ID NO:51.10. The pharmaceutical composition of any one of claims 1 to 9, whereinthe controlled-release PTH compound is water-insoluble.
 11. Thepharmaceutical composition of claim 10, wherein the water-insolublecontrolled-release PTH compound is selected from the group consisting ofcrystals, nanoparticles, microparticles, nanospheres and microspheres.12. The pharmaceutical composition of claim 10 or 11, wherein thewater-insoluble controlled-release PTH compound comprises at least onePTH molecule or moiety non-covalently embedded inpoly(lactic-co-glycolic acid) (PLGA).
 13. The pharmaceutical compositionof any one of claims 1 to 9, wherein the controlled-release PTH compoundis water-soluble.
 14. The pharmaceutical composition of any one ofclaims 1 to 9 or 13, wherein the controlled-release PTH compound is acompound of formula (Ia) or (Ib) or a pharmaceutically acceptable saltthereofZL²-L¹-D)_(x)  (Ia)DL¹-L²-Z)_(y)  (Ib), wherein -D is a PTH moiety; -L¹- is a reversibleprodrug linker moiety connected to the PTH moiety -D through afunctional group of PTH; -L²- is a single chemical bond or a spacermoiety; —Z is a water-soluble carrier moiety; x is an integer selectedfrom the group consisting of 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13,14, 15 or 16; and y is an integer selected from the group consisting of1, 2, 3, 4 and
 5. 15. The pharmaceutical composition of any one ofclaims 1 to 14, wherein the condition that can be treated, controlled,delayed or prevented with PTH is selected from the group consisting ofhypoparathyroidism, hyperphosphatemia, osteoporosis, fracture repair,osteomalacia, osteomalacia and osteoporosis in patients withhypophosphatasia, steroid-induced osteoporosis, male osteoporosis,arthritis, osteoarthritis, osteogenesis imperfect, fibrous dysplasia,rheumatoid arthritis, Paget's disease, humoral hypercalcemia associatedwith malignancy, osteopenia, periodontal disease, bone fracture,alopecia, chemotherapy-induced alopecia, and thrombocytopenia.
 16. Thepharmaceutical composition of any one of claims 1 to 15, wherein thecondition that can be treated, controlled, delayed or prevented with PTHis hypoparathyroidism.